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COLLEGE  OF   OSTEOPATHIC   PHYSICIANS 
AND  SURGEONS   •  LOS  ANGELES,  CALIFORNIA 


Digitized  by  the  Internet  Archive 

in  2007  with  funding  from 

Microsoft  Corporation 


http://www.archive.org/details/fourepochsofwomaOOgalbiala 


THE 

FOUR   EPOCHS 


OF 


WOMAN'S  LIFE 

A  Study  in  Hygiene 


NK 


BY 

ANNA  M.  GALBRAITH,  M.D. 


Author  of  "  Hygiene  and  Physical  Culture  for  Women  "  j  Fellow  cf  the 

New  York  Academy  of  Medicine  ;  Ex-President  of  the  Alumnae 

Association,  Woman's  Medical  College  of  Pennsylvania  t 

Attending   Physician,  Neurological  Department, 

New  York   Orthopedic    Hospital  and 

Dispensary. 


WITH  AN 

INTRODUCTORY  NOTE 

BY 

JOHN  H.  MUSSER,  rVLD. 

Professor  of  Clinical  Medicine,  University  of  Pennsylvania. 

SECOND  EDITION,  REVISED  AND  ENLARGED 


PHILADELPHIA,  NEW  YORK,  LONDON 

W.  B.  SAUNDERS  &  COMPANY 

1904 


Set  up,  printed,  and  copyrighted  November,  1901.     Revised,  electrotyped, 
reprinted,  and  recopyrighted  August,  1903. 


Copyright,  1903,  by  W.  B.  Saunders  &  Company. 


Registered  at  Stationers'  Hall,  London,  England. 


Reprinted  October,  1904. 


press  or 

W.   B.    SAUNOERS  &  COMPANY. 


"As  in  a  building 
Stone  rests  on  stone,  and  wanting  the  foundation 
All  would  be  wanting,  so  in  human  life 
Each  action  rests  on  the  foregoing  event 
That  made  it  possible,  but  is  forgotten 
And  buried  in  the  earth." 

— Longfellow. 


INTRODUCTORY   NOTE 


It  has  been  well  said  that  the  bulwarks  of  a  nation 
are  the  mothers.  Any  contribution  to  the  physical, 
and  hence  the  mental,  perfection  of  woman  should  be 
welcomed  alike  by  her  own  sex,  by  the  thoughtful  citi- 
zen, by  the  political  economist,  and  by  the  hygienist. 
Observation  of  the  truths,  expressed  in  a  modest, 
pleasing,  and  conclusive  manner,  in  the  essay  of  Dr. 
Galbraith  contribute  to  this  end.  These  truths  should 
be  known  by  every  woman,  and  I  gladly  commend  the 
essay  to  their  thoughtful  consideration. 

John  H.  Musser,  M.D., 

Professor  of  Clinical  Medicine 

in  the  University  of  Pennsylvania. 


^£<?o4 


PREFACE  TO  THE  SECOND  EDITION. 


The  author  takes  this  opportunity  to  thank  the 
medical  profession  and  the  laity  for  the  very  cordial 
reception  which  has  been  tendered  the  first  edition  of 
this  small  volume. 

The  necessity  for  the  use  of  technical  expressions 
in  a  book  written  expressly  for  the  laity  must  always 
be  a  matter  of  regret.  And  only  those  who  have  at- 
tempted to  write  a  similar  work  can  fully  appreciate 
the  truth  of  Herbert  Spencer's  remark,  that  "  Nothing 
is  so  difficult  as  to  write  an  elementary  book  on  sci- 
entific subjects." 

The  author  has  added  to  this  edition  a  section  on 
"  The  Hygiene  of  Puberty,"  one  on  "  Hemorrhage  at 
the  Menopause  a  Significant  Symptom  of  Cancer," 
and  one  on  "  The  Hygiene  of  the  Menopause." 

Anna  M.  Galbraith. 
15  West  Ninety-first  Street,  New  York, 


PREFACE. 

"Ignorance  is  the  curse  of  God; 
Knowledge,  the  wings  wherewith  we  fly  to  heaven." 

—"Henry    VI." 

Perfect  health  is  essential  to  perfect  happiness. 
The  greater  the  knowledge  of  the  laws  of  nature,  and 
the  more  closely  these  laws  are  lived  up  to,  so  much 
nearer  "  ideal  "  will  be  the  health  and  happiness  of 
the  individual.  Hence  the  necessity  that  these  same 
laws  should  be  as  familiar  to  the  adult  man  and 
woman  as  the  alphabet.  Further,  with  our  present 
knowledge  of  the  certain  suffering,  disease,  and  death 
that  are  bred  by  ignorance  of  all  these  subjects,  it  is 
litttle  less  than  criminal  to  allow  girls  to  reach  the 
age  of  puberty  without  the  slightest  knowledge  of 
the  menstrual  function ;  young  women  to  be  married 
in  total  ignorance  of  the  ethics  of  married  life ;  women 
to  become  mothers  without  any  conception  of  the 
duties  of  motherhood ;  other  women,  as  the  time  ap- 
proaches, to  live  in  dread  apprehension  of  "  the  change 
of  life ;"  and  many  women  unnecessarily  to  succumb 
to  disease  at  this  time. 

The  masses  of  women  have  at  last  awakened  to  a 
sense  of  the  awful  penalties  which  they  have  paid  for 
their   ignorance   of   all  those  laws   of   nature   which 


io  Preface. 

govern  their  physical  being,  and  to  feel  keenly  the 
necessity  for  instruction  at  least  in  the  fundamental 
principles  which  underlie  the  various  epochs  of  their 
lives;  and  it  is  in  response  to  a  widespread  demand 
that  this  small  volume  has  been  written. 

This  is  preeminently  the  day  of  preventive  medi- 
cine ;  and  the  physician  who  can  prevent  the  origin  of 
disease  is  a  greater  benefactor  than  the  one  who  can 
lessen  the  mortality  or  suffering  after  the  disease  has 
occurred. 

Anna  M.  Galbraith. 

15  West  Ninety-first  Street,  New  York, 


CONTENTS 


INTRODUCTION 

EDUCATION  AS  THE  CONTROLLING  FACTOR  IN 
THE  PHYSICAL  LIFE  OF  WOMAN 

PAGE 

Huxley's  Definition  of  Education  ;  the  Correlation  of  Mind 
and  Body ;  the  Emotional  Nature ;  Age  for  Going  to 
School ;  the  Effect  of  the  Study  of  the  Scientific 
Branches;   Industrial  Education 17-25 


PART  I.— MAIDENHOOD 

CHAPTER   I. 

PUBERTY 

Sexual  Development ;  Age  of  Puberty  ;  Physical  Changes  at 
Puberty  ;  First  Onset  of  Menstruation  ;  Psychic  Changes 
at  Puberty 26-30 

CHAPTER   II. 
HYGIENE  OF  PUBERTY 

Home  Life;  Corsets;  Shoes;  Underwear;  Nutrition;  Diet; 
Water ;  Constipation  ;  School  Life ;  Spinal  Curvature  ; 
Exercise;  Walking;  Running 3I-44 

CHAPTER  III. 

ANATOMY  OF  THE  FEMALE  GENERATrVE  ORGANS 

The  Vulva;  the  Hymen;  Condition  of  the  Hymen  as  a  Proof 
of  Virginity;  the  Bladder ;  Vagina ;  Uterus;  Respirator)' 
Movements  of  the  Uterus  ;   Fallopian   Tubes;  Ovaries    .       45-51 


1 2  Contents 

CHAPTER   IV. 
PHYSIOLOGY  OF  THE  FEMALE  GENERATIVE  ORGANS 

PAGE 

Ovulation  ;  Etiology  of  Menstruation  ;  Uterine  Nerve-supply  ; 
the  Function  of  the  Uterus;  Stages  of  the  Menstrual 
Cycle ;  Average  Duration  of  the  Menstrual  Flow ;  Char- 
acter of  the  Flow ;  Relation  of  Ovulation  to  Menstrua- 
tion; the  Menstrual  Wave;  Definition  of  Menstruation  ; 
Premonitory  Symptoms  of  the  Flow ;  Hygiene  of  Men- 
struation            52-64 

CHAPTER   V. 
THE  ANOMALIES  OF  MENSTRUATION 

Menorrhagia  and  Metrorrhagia ;  Dysmenorrhea ;  Amenor- 
rhea; Leucorrhea;  Pruritus  Vulvae 65-71 

CHAPTER   VI. 
THE  MARRIAGE  QUESTION 

Herbert  Spencer's  Definition  of  Love ;  What  Constitutes  a 
Suitable  Husband ;  Best  Age  for  Marriage;  Shall  Cousins 
Marry  ?  Contraindications  to  Marriage  ;  Do  Reformed 
Profligates  Make  Good  Husbands  ?  the  Proper  Length  of 
Time  for  the  Engagement ;  the  Right  Time  of  the  Year 
to  Marry  ;  the  Selection  of  the  Wedding  Day     ....       72-81 


PART  II.— MARRIAGE 

CHAPTER   VII. 

THE  ETHICS  OF  MARRIED  LIFE 

The  Wedding  Journey;  the  Ethics  of  Married  Life;  Shall 
Husband  and  Wife  Occupy  the  Same  Bed  ?  the  Consum- 
mation of  Marriage ;  the-  Marital  Relation  ;  Times  when 
Marital  Relations  Should  be  Suspended 82-91 


Contents  13 

CHAPTER   VIII. 
SEXUAL  INSTINCT  IN  WOMEN 

PAGE 

Sexual    Instinct   in    Women ;    Excessive  Coitus ;    Causes   of 

Sexual    Excitability 92-97 

CHAPTER    IX. 
STERILITY 

Sterility ;  the  Prevention  of  Conception  and  the  Limitation  of 

Offspring;  the  Crime  of  Abortion  ;  Infidelity  in  Women     98-m 


PART  III.— MATERNITY 

CHAPTER    X. 

PREGNANCY 

Nature  of  Conception ;  Pregnancy  Defined  ;  Duration  of  Preg- 
nancy ;  the  Signs  of  Pregnancy  ;  Quickening ;  the  De- 
termination of  Sex  at  Will  ;  the  Influence  of  the  Male 
Sexual  Element  on  the  Female  Organism;  Heredity; 
Hygiene  of  Pregnancy  ;  Causes  of  Miscarriage  ....    1 12-133 

CHAPTER   XI. 

THE  CONFINEMENT 

Preparation  for  the  Confinement ;  Signs  of  Approaching 
Labor;  Symptoms  of  Actual  Labor;  The  Confinement- 
bed;  the  Process  of  Labor 134-14Q 

CHAPTER    XII. 

THE  LYING-IN 

Management  of  the  Lying-in  ;  Lactation  ;  Nursing     ....   150-159 


14  Contents 

CHAPTER   XIII. 
THE  NEW-BORN  INFANT 

PAGE 

The  Infant's  Toilet;  the  Crib;  Feeding  of  Infants  ;  the  Wet- 
nurse  ;  Artificial  Feeding ;  Characteristics  of  Healthy  In- 
fants ;  the  Stools ;  Constipation;  Urination;  Teething  .    .    160-183 


PART  IV.— THE  MENOPAUSE 

CHAPTER   XIV. 

THE  MENOPAUSE 

Average  Duration  of  the  Menstrual  Function ;  Duration  of 
Menopause  ;  the  Menopause ;  General  Phenomena  of 
the  Menopause  ;  Prominent  Symptoms  of  Menopause ; 
Pathologic  Conditions  of  Menopause  ;  Hemorrhage  at 
the  Menopause  a  Significant  Symptom  of  Cancer ;  Causes 
of  Suffering  at  Menopause 184-21 1 

CHAPTER   XV. 
HYGIENE  OF  THE  MENOPAUSE 

Diet ;  Constipation  ;  Stimulants ;  the  Kidneys ;  Skin  ;  Turkish 
Baths ;  Massage ;  Exercise ;  Profuse  Menstruation ;  Hem- 
orrhage ;  Mental  Therapeutics 212-218 

CHAPTER    XVI. 
HINTS  FOR  HOME  TREATMENT 

Indigestion  ;    Constipation  ;     Enemas  ;     Diarrhea  ;    Vaginal 

Douche;  Baths;  Headache;  Fainting;  Hemorrhage    .   219-232 


GLOSSARY 233-239 

INDEX      241-246 


THE 

FOUR    EPOCHS 

OF 

WOMAN'S    LIFE 


15 


INTRODUCTION. 


EDUCATION   AS  THE   CONTROLLING 

FACTOR  IN  THE  PHYSICAL  LIFE 

OF  WOMAN. 

Huxley's  Definition  of  Education;  the  Correlation 
of  Mind  and  Body;  the  Emotional  Nature;  Age 
for  Going  to  School;  the  Effect  of  the  Study  of 
the  Scientific  Branches;  Industrial  Education. 

"What  is   man, 
If    his    chief    good,   and    market    of   his   time, 
Be   but    to   sleep   and    feed?      A    beast;    no   more. 
Sure,  He  that  made  us  with  such  large  discourse, 
Looking  before  and  after,  gave  us  not 
That  capability  and   godlike  reason 
To  fust  in  us  unused." 

— "Hamlet." 

The  word  education  is  here  used  in  its  broadest 
sense,  and  is  meant  to  include  the  physical,  mental, 
intellectual,  and  industrial.  Huxley's  definition  is 
as  follows :  "  Education  is  the  instruction  of  the 
intellect  in  the  laws  of  nature,  under  which  I  in- 
clude not  only  things  and  their  forces,  but  men  and 
their  ways;  and  the  fashioning  of  their  affections 
and  of  the  will  into  an  earnest  and  living  desire  to 
move  in  harmony  with  these  laws.  That  man,  I 
think,  has  had  a  liberal  education  who  has  been  so 

17 


1 8  Education. 

trained  in  his  youth  that  his  body  is  the  ready 
servant  of  his  will,  and  does  with  ease  and  pleasure 
all  the  work  that,  as  a  mechanism,  it  is  capable  of; 
whose  intellect  is  a  clear,  cold,  logic  engine,  to  be 
turned  to  any  kind  of  work,  to  spin  the  gossamers 
as  well  as  to  forge  the  anchors  of  the  mind ;  whose 
mind  is  stored  with  the  great  and  fundamental 
truths  of  nature  and  the  laws  of  her  operations; 
one  whose  passions  are  trained  to  come  to  heel  by 
a  vigorous  will,  the  servant  of  a  tender  conscience; 
one  who  has  learned  to  love  all  beauty,  whether  of 
nature  or  of  art,  to  hate  all  vileness,  and  to  respect 
others  as  himself." 

The  Correlation  of  Mind  and  Body. — It  is  of  the 
utmost  importance  that  the  mutual  reaction  of  mind 
and  body  upon  each  other  should  be  thoroughly 
understood.  This  reaction  is  so  constant,  so  intri- 
cate, and  so  complex  that  it  is  at  times  difficult  to 
say  which  is  cause  and  which  effect.  Does  the 
depressed  state  of  the  mind  cause  the  indigestion, 
or  is  a  torpid  liver  the  real  seat  of  the  melancholia  ? 

The  brain  is  the  most  delicately  constructed  or- 
gan in  the  entire  body.  In  the  lower  animals  the 
brain  is  simply  the  great  nerve-center  which,  with 
its  prolongation  the  spinal  cord,  presides  over  all 
the  functions  of  life  which  differentiate  the  animal 
from  the  vegetable.  In  the  human  being  the  brain 
is  much  more  highly  developed  and  complicated; 


Correlation  of  Mind  and  Body.  19 

and  is,  in  addition,  the  seat  of  the  mind,  the  intellect, 
and  the  affections.  Like  all  the  other  tissues  of 
the  body,  the  brain  receives  its  nourishment  from 
the  blood-vessels  which  pass  through  it,  and  its 
healthy  maintenance  is  in  a  direct  ratio  to  the  con- 
dition of  its  blood-supply. 

A  most  interesting  psychologic  study  is  found  in 
the  case  of  cerebral  paralysis  of  young  children, 
where  there  is  mental  defect  amounting  to  stupidity 
or  imbecility,  accompanied  by  extensive  paralysis 
of  the  body,  so  that  the  child  is  not  able  to  sit  up. 
With  the  gradual  improvement  of  the  physical  con- 
dition, so  that  the  muscles  become  firm  and  the 
child  can  sit,  stand,  and  even  walk,  there  is  a  cor- 
responding mental  development;  from  being  stupid 
and  dull,  the  expression  of  the  face  brightens  and 
becomes  intelligent;  the  child  talks  quite  as  well 
as  other  children  of  its  age,  and  sometimes  becomes 
really  intellectually  precocious.  Here  we  see  the 
development  of  the  brain  as  a  direct  result  of  the 
improved  physical  condition.  In  certain  cases  of 
insanity,  on  the  contrary,  we  find  that  the  wasting 
away  of  the  body  results  from  the  disease  of  the 
brain,  i.  e.,  the  disease  of  the  brain  has  wrought 
the  wreck  of  the  body. 

From  these  pathologic  studies,  or  studies  of  how 
the  diseased  state  of  the  brain  and  body  may  be 
overcome  by  physical  development,  on  the  one  hand, 


20  Education. 

and,  on  the  other  hand,  how  the  healthy  body  may 
be  wrecked  by  disease  of  the  brain,  we  will  turn 
to  a  consideration  of  the  effect  of  the  development 
of  the  mind  and  intellect  upon  the  physical  health. 

On  a  girl's  entering  Vassar  College  an  exact  and 
detailed  physical  examination  is  made  by  the  resi- 
dent physician,  a  health  record  is  kept  during  her 
stay  there,  and  at  the  time  of  her  graduation  a  final 
physical  examination  is  made.  As  a  result  of  these 
statistics  Dr.  Thelberg  says :  "  These  statistics,  now 
covering  a  number  of  years,  show  that  not  only  can 
girls  profitably  take  a  college  education,  that  is  ac- 
complished; but  will  prove  that  grave  physical  im- 
perfections can  be  corrected  in  the  period  between 
eighteen  and  twenty-two  years  of  age,  coincidently 
with  the  development  of  the  mind  along  the  lines 
of  college  work;  the  college  work,  if  not  excessive 
in  amount,  being  a  real  and  most  important  factor 
in  the  physical  development." 

But  a  still  more  striking  proof  can  be  cited  of 
the  beneficial  result  of  mental  and  intellectual  oc- 
cupation upon  the  bodily  health.  At  Vassar  a  great 
deal  of  attention  is  very  properly  paid  to  general 
hygiene  and  the  physical  development,  in  addition 
to  the  natural  advantages  of  outdoor  life  in  the 
country. 

Take,  for  example,  a  woman's  medical  college 
located  in  the  city:    the  four  years'  course  places 


Correlation  of  Mind  and  Body.  21 

the  greatest  strain  on  both  mind  and  body;  prac- 
tically no  time  is  left  for  recreation,  and  very  much 
too  little  time  is  spent  in  sleep ;  the  amount  of  exer- 
cise taken  is  the  minimum.  Yet  in  spite  of  all  these 
disadvantages  under  which  the  young  women  labor, 
a  great  many  of  them  who  enter  far  below  par  in 
health,  or,  indeed,  on  the  fair  road  to  become  chronic 
invalids,  graduate  very  greatly  improved  in  health. 

The  Emotional  Nature. —  Formerly  much  more 
than  now,  owing  to  the  defective  methods  of  her 
education  and  mode  of  life,  the  emotional  nature  of 
woman  was  allowed  to  run  riot.  The  child  was 
coddled;  the  girl  was  allowed  to  grow  up  without 
any  of  the  discipline  which  young  men  receive  in 
their  college  and  business  life,  and  little  or  no  at- 
tention was  paid  to  her  physical  development.  The 
woman  naturally  became  a  bundle  of  nerves,  highly 
irritable,  unreasonable,  and  hysterical.  All  this  re- 
acted in  the  most  detrimental  manner  upon  her 
physical  health. 

The  seed  for  much  of  this  emotional  hyperesthesia 
is  sown  in  childhood.  From  birth  until  the  end  of 
the  eighth  year  should  be  one  grand  holiday.  Dur- 
ing this  time  the  child  develops  very  rapidly,  espe- 
cially during  the  first  two  years  of  life.  And  at 
the  end  of  the  eighth  year  the  brain  has  attained 
to  within  a  few  ounces  of  its  full  weight.  The 
muscular  system  has  been  developed  together  with 


22  Education. 

the  coordination  of  motion.  The  child  has  learned 
to  use  a  language  fairly  well;  she  has  developed 
an  excellent  memory  and  is  most  inquisitive  and  ac- 
quisitive. 

Another  method  for  undermining  the  healthy  tone 
of  the  nervous  system  is  the  intricate  dances  taught 
very  young  children  and  then  placing  them  on  public 
exhibition,  where  they  are  wrought  up  to  the  highest 
pitch.  From  a  purely  medical  standpoint,  children 
under  eight  years  of  age  should  not  be  allowed  to 
take  dancing  lessons.  After  this  age  a  moderate 
amount  of  dancing  in  a  well-ventilated  room  is  good 
exercise. 

Children's  parties  belong  in  the  same  category, 
and,  on  account  of  the  injurious  effects  on  the 
nervous  system,  should  be  tabooed.  They  are  too 
exciting,  and  cause  an  overstimulation  of  the  nerv- 
ous system  and  a  precocious  childhood  and  puberty. 

Instead  of  rearing  an  oversensitive  hot  -  house 
plant  that  must  be  fragile  in  the  extreme,  strive 
to  rear  a  sturdy  plant  that  can  hold  its  own  amid 
the  storms.  The  child  should  spend  as  much  of 
its  life  as  possible  in  the  open  air,  and  in  the  warm 
months  live  out-of-doors.  City  children  should  be 
taken  to  the  seashore  or  country  to  spend  several 
months  every  summer.  Together  with  outdoor 
sports,  gymnastics  adapted  to  the  age  of  the  child 
should  be  begun  early  and  continued  throughout 


Correlation  of  Mind  and  Body.  23 

life.  Good  muscular  development  is  attended  with 
good  digestion  and  a  well-balanced  nervous  system. 

Until  after  the  twelfth  year  there  should  be  ab- 
solutely no  difference  between  the  physical,  mental, 
or  industrial  education  of  girls  and  boys.  And, 
still  further,  they  should  be  encouraged  to  have  their 
sports  together ;  this  will  improve  the  girls  physically 
and  broaden  them  mentally,  and  will  do  a  great 
deal  to  take  the  rough  edges  off  the  boys.  After 
this  age  it  will  be  wise  to  allow  slight  barriers  to 
grow  up,  without  calling  the  attention  of  any  one 
to  the  fact,  that  will  cause  the  companionship  to 
be  less  free  and  unrestrained. 

Age  for  Going  to  School.— Although  the  child 
may  be  allowed  to  go  to  kindergarten  long  before 
this  time,  it  should  not  be  allowed  to  enter  the 
school-room  before  eight  years  of  age.  And  from 
eight  to  twelve  years,  not  more  than  four  hours 
a  day  should  be  spent  in  study.  After  this  time  it 
may  be  put  down  more  closely  to  intellectual  work ; 
but  no  more  mental  work  should  be  required  than 
will  enable  the  girl  to  enter  college  at  eighteen. 
And  eighteen  years  of  age  is  as  young  as  any  girl 
should  be  allowed  to  go  to  college;  after  this  age 
the  mind  is  more  matured  and  acquires  knowledge 
more  easily  than  before,  while  the  development  of 
the  body  is  less  rapid.  The  physical  system  has 
become  more  stable.     The  literature  indulged  in 


24  Education. 

by  girls  under  eighteen  years  of  age  should  be  most 
carefully  selected. 

The  Effect  of  the  Study  of  the  Scientific  Branches. 
— A  knowledge  of  the  laws  of  nature  is  essential 
to  health;  hence  the  necessity  for  the  study  of  the 
natural  sciences  —  anatomy,  physiology,  chemistry, 
physics,  and  zoology.  Aside  from  the  intrinsic  value 
of  this  knowledge,  it  is  almost  universally  conceded 
that  these  studies  develop  the  judgment;  and  no 
one  will  have  the  temerity  to  deny  that  a  lack  of 
judgment  must  undermine  the  health  as  well  as  the 
success  and  happiness  of  the  individual. 

Industrial  Education.  —  When  it  is  considered 
how  intimate  are  the  relations  between  the  physical 
and  the  psychic  states,  and  how  often  the  psychic 
condition  leads  to  actual  disease,  and  that  often  of 
the  most  incurable  type,  it  needs  no  demonstration 
that  a  mental  occupation  which  will  take  the  woman 
out  of  herself  is  a  physical  necessity.  Therefore 
when  the  girl  has  reached  the  subjective  limit  of 
her  intellectual  education, —  that  is,  when  she  has 
reached  the  limit  of  her  capacity  or  taste, —  it  is 
essential  to  her  physical  well-being  that  she  should 
turn  her  attention  to  some  industrial  occupation. 
This  may  be  housekeeping  or  any  other  occupation 
for  which  she  has  taste  or  talent.  A  healthy  mental 
occupation  is  an  absolute  necessity  to  prevent  the 
individual  from  becoming  self-centered.     And  to 


Correlation  of  Mind  and  Body.  25 

become  self -centered  is  the  first  step  on  the  certain 
road  to  chronic  invalidism. 

A  most  important  part  of  an  education  is  the 
knowledge  of  how  to  procure  the  most  perfect  de- 
velopment of  the  body  possible,  and  how  to  maintain 
the  health.  This  has  not  been  touched  upon  here, 
since  the  outlines  for  the  general  physical  education 
have  already  been  given  in  "  Hygiene  and  Physical 
Culture  for  Women,"*  and  the  present  volume  con- 
cerns itself  only  with  the  four  critical  epochs  of 
woman's  life. 

With  this  broad  view  of  an  education,  as  a  means 
to  procure  the  best  physique  possible;  a  mind  dis- 
ciplined to  meet  to  the  greatest  advantage  all  the 
vicissitudes  of  life;  an  intellect  developed  along  the 
lines  of  its  greatest  possibilities;  and  an  occupation 
chosen  in  accordance  with  the  tastes  and  talents  of 
the  individual;  it  becomes  an  incontrovertible  fact 
that  the  education  is  the  controlling  factor  in  the 
physical  life  of  every  woman. 

"  Be  not  simply  good ;  be  good  for  something." 

— Thoreau. 


*By    Anna    M.    Galbraith,    M.    D. ;    published    by    Dodd, 
Mead  &   Co. 


PART  I.-MAIDENHOOD. 


CHAPTER  I. 

PUBERTY. 


Sexual  Development;  Age  of  Puberty;  Physical 
Changes  at  Puberty;  First  Onset  of  Menstrua- 
tion; Psychic  Changes  at  Puberty. 

"Self-reverence,  self-knowledge,   self-control, 
These  three   alone  lead  life  to  sovereign  power." 

— "CEnone." 

Sexual  Development. — Sexual  development  goes 
on  during  all  the  years  of  childhood,  but  is  not 
complete  in  the  female  sex  until  between  the  twenty- 
second  and  the  twenty-fifth  year.  If  the  child  has 
no  inherited  taint,  and  has  been  properly  educated 
morally,  physically,  and  intellectually,  it  must  follow 
that  the  structural  development  of  the  pelvic  organs 
has  been  normal ;  and  normal  organs  always  per- 
form their  functions  perfectly. 

The  commencement  of  the  ovarian  function  does 
not  cause  any  more  profound  change  in  the  system 
and  habits  than  does  dentition.  The  various  epochs 
of  life  are   generally  spoken   of  as   if  they  were 

26 


Puberty.  2J 

paroxysmal  —  as  though  they  were  separated  by 
some  tremendous  chasm,  which  had  to  be  leapt  over 
or  fallen  into.  Nature  makes  no  such  egregious 
blunders ;  preparations  for  every  change  in  life  have 
been  going  on  for  a  very  long  time  before  the  evi- 
dences of  such  change  become  manifest. 

In  a  healthy  girl  the  psychic  and  physical  changes 
incident  to  puberty  occur  so  gradually  as  to  escape 
the  girl's  own  notice.  The  first  and,  if  the  girl  has 
not  been  properly  prepared  for  it,  always  startling 
change  is  the  appearance  of  the  menstrual  flow. 
The  mother  who  has  not  told  her  daughter  of  this 
coming  change  in  her  life  before  it  is  due  has  com- 
mitted a  serious  error;  it  is  no  uncommon  occur- 
rence for  girls  who  know  nothing  of  this  function 
to  get  into  a  tub  of  cold  water  to  stop  the  flow ;  and 
if  they  stay  in  long  enough,  it  generally  does  stop, 
and  the  girl's  health  may  be  ruined  for  life. 

The  opinion  of  Dr.  Ely  van  de  Warker  is  that 
"  if  healthy  ovulation  is  the  outcome  of  healthy 
childhood,  the  function  will  obey  the  law  of  peri- 
odicity year  by  year,  and  all  this  time  the  young 
woman  will  be  able  to  sustain  uninterrupted  physical 
and  intellectual  work  as  well  as  the  young  man. 
Not  that  the  laws  of  health  may  be  violated  with 
impunity  at  puberty  or  any  other  time  of  a  woman's 
life;  but  a  law  of  health  is  no  more  binding  upon 
a  young  woman  than  it  is  upon  a  young  man;  and 


28  Maidenhood. 

there  really  is  no  such  thing  as  one  law  for  women 
and  another  for  men." 

Age  of  Puberty. — In  the  temperate  regions  the 
age  of  puberty  is  reached  between  the  ages  of  twelve 
and  fourteen  years.  The  girl  is  then  said  to  be 
nubile;  that  is,  as  soon  as  menstruation  appears  it 
is  possible  for  her  to  bear  children;  but  she  is  by 
no  means  sufficiently  developed  to  do  so,  as  she 
herself  will  not  be  completely  developed  physically 
or  mentally  before  the  age  of  twenty-two  or  twenty- 
five  years. 

Physical  Changes  at  Puberty.  —  The  physical 
changes  that  gradually  take  place,  beginning  at  the 
time  of  puberty,  are:  the  breasts,  pelvis,  and  neck 
enlarge;  hair  develops  over  the  pubis  and  in  the 
arm-pits;  the  voice  alters.  As  a  rule,  women  con- 
tinue to  grow  in  stature  until  the  twenty-fifth  year. 
It  is  said  that  brunettes  develop  sooner  than  blondes, 
and  that  large  women  develop  more  slowly  than 
women  of  small  stature;  city  girls  develop  younger 
than  girls  brought  up  in  the  country.  Whatever 
stimulates  the  emotions  causes  a  premature  devel- 
opment of  the  sexual  organs;  as  children's  parties, 
late  hours,  sensational  novels,  loose  stories,  the 
drama  and  the  ball-room,  talk  of  beaux,  of  love 
and  marriage,  and  children  being  surrounded  with 
the  atmosphere  of  riper  years.  It  is  generally  be- 
lieved that  early  stimulation  of  the  sexual  instincts 


Puberty.  29 

leads  to  the  premature  establishment  of  puberty,  as 
do  also  spiced  foods  and  alcoholic  beverages. 

First  Onset  of  Menstruation. —  Sometimes  the 
first  menstrual  discharge  appears  suddenly,  lasts  for 
a  few  days,  and  then  stops;  it  may  appear  after  an 
interval  of  two  or  three  weeks,  or  not  for  several 
months.  If  for  several  months  the  flow  appears 
at  the  regular  time,  and  the  quantity  is  about  the 
same  as  the  first,  the  menstrual  habit  may  be  said 
to  be  established.  The  mode  of  onset  varies  con- 
siderably within  the  limits  of  health.  So  long  as 
the  general  health  remains  good,  no  anxiety  need 
be  felt  in  regard  to  the  establishment  of  the  men- 
strual function. 

In  other  cases  there  may  be  a  discharge  of  blood 
at  the  first  period,  and  none  afterward  for  several 
months;  in  other  words,  menstruation  may  be  es- 
tablished suddenly,  intermittently,  or  gradually.  It 
must  be  remembered  that  certain  pathologic  condi- 
tions cause  many  disturbances  connected  with  the 
onset  of  puberty. 

Psychic  Changes  at  Puberty. —  The  angular, 
gawky  feeling  gradually  disappears;  the  girl  be- 
comes self-conscious;  new  impulses  arise,  and  she 
gives  up  many  of  the  hoydenish  ways  of  childhood. 
The  girl's  imagination  is  more  lively,  and  just  at  this 
time  mathematics  form  an  excellent  subject  for  men- 
tal occupation.     The  girl  now  begins  to  question 


30  Maidenhood. 

the  whys  and  wherefores,  and  demands  reasons  for 
the  course  that  is  laid  out  for  her,  and  is  full  of 
ideas  of  her  own;  so  that  while  as  a  child  she  had 
accepted  almost  unquestioningly  the  commands  of 
her  parents,  she  can  be  managed  now  only  through 
the  power  of  reason.  And  this  is  just  as  it  should 
be,  for  the  girl  has  reached  the  years  of  discretion, 
and  now  is  the  time  when  her  reason  and  judgment 
are  capable  of  rapid  cultivation. 


CHAPTER  II. 

HYGIENE  OF  PUBERTY. 

Home  Life;  Corsets;  Shoes;  Underwear;  Nutri- 
tion; Diet;  Water;  Constipation;  School  Life; 
Spinal  Curvature ;  Exercise;  Walking;  Running. 

"Every    man    is    the   architect    of   his   own    fortune." 

Pseudo-Sau,ust. 

Home  Life. — With  beginning  menstruation  the 
equilibrium  of  the  body  is  very  easily  disturbed,  so 
that  even  in  the  case  of  the  healthy  girl  some  pre- 
cautions should  be  taken  and  a  rational  regime 
should  be  adhered  to ;  while  in  the  case  of  the  deli- 
cate girl  a  still  more  careful  attention  will  have  to 
be  directed  toward  her  weak  points,  in  order  that 
she  may  develop  into  a  healthy  woman. 

For  every  girl  at  this  time  of  life  home  is  pre- 
eminently the  place;  so  that  she  may  not  only  have 
the  benefit  of  a  mother's  watchful  care,  but  also 
lead  a  life  as  free  from  conventionalities  and  as 
much  in  the  open  air  as  possible.  No  girl  should 
be  sent  away  to  school  at  this  period  of  rapid  growth 
and  development;   nor  should  girls  of  the  working 

3i 


32  Maidenhood. 

classes,  when  it  can  possibly  be  avoided,  be  sent 
out  to  fill  positions  as  clerks  in  illy  ventilated  stores, 
in  factories,  or  as  domestics.  If  a  girl  can  be  kept 
at  home  until  she  is  eighteen  years  old,  she  will  be 
a  much  stronger,  healthier  woman  than  would  other- 
wise be  possible. 

Corsets. — At  this  period  of  life  it  is  particularly 
necessary  that  the  clothing  should  be  warm  and  at 
the  same  time  sufficiently  loose  to  prevent  the  con- 
striction of  any  part  of  the  body.  And  whatever 
the  adult  woman  may  elect  to  do  in  the  matter  of 
wearing  corsets  herself,  she  does  her  young  daugh- 
ter an  irreparable  injury  by  constricting  and  mould- 
ing her  growing  body  in  these  corset-splints.  Cor- 
sets placed  on  the  young  girl  interfere  with  the 
functions  of  circulation,  respiration,  digestion,  and 
of  the  pelvic  organs,  also  with  muscular  develop- 
ment. In  addition  to  all  this,  the  girl  is  handicapped 
in  taking  all  outdoor  exercises  and  athletic  sports. 

The  lungs,  heart,  and  great  blood-vessels  ?re 
placed  in  and  completely  fill  an  air-tight,  distensible 
cage,  which  is  most  distensible  at  its  base. 

The  least  chest  girth  of  the  adult  woman  —  that 
is,  the  under-arm  girth  around  the  chest  —  that  is 
consistent  with  health  is  twenty-eight  inches;  and 
this  girth  must  be  enlarged  three  inches  in  forced 
inspiration.  In  ordinary  respiration  the  waist  ex- 
pansion should  be  one-half  to  one  inch,  while  during 


Hygiene  of  Puberty.  33 

great  muscular  activity  it  should  be  from  one  and 
a  half  to  three  or  four  inches.  One-third  of  the 
lungs  lie  below  the  point  of  beginning  corset  pres- 
sure, so  that  with  tight  corsets  this  amount  of  lung 
substance  must  be  more  or  less  useless. 

It  is  self-evident  that  any  restriction  placed  about 
the  waist,  by  preventing  the  full  expansion  of  the 
ribs  and  the  descent  of  the  diaphragm,  will  further 
embarrass  the  heart's  action  by  diminishing  the 
amount  of  room  it  has  to  work  in,  at  the  same  time 
that  it  diminishes  the  amount  of  oxygen  which  is 
inspired.  Fresh  air  is  by  far  the  most  important 
part  of  the  daily  food.  It  is  in  the  lungs  that  the 
blood  throws  off  its  carbonic  acid  and  other  impuri- 
ties; but  it  is  able  to  do  this  only  when  the  lungs 
are  supplied  with  an  abundance  of  oxygen.  Every 
inch  which  a  woman  adds  to  her  chest  measure  adds 
to  the  measure  of  her  days. 

Great  physical  injury  has  followed  women  play- 
ing lawn-tennis  while  tightly  corseted.  And  although 
dancing  is  a  much  milder  exercise,  since  it  frequently 
takes  place  in  an  overheated  and  poorly  ventilated 
room,  fatal  results  occasionally  occur  from  the  same 
cause. 

Standing  erect  calls  into  action  almost  all  the 

muscles  of  the  trunk,  neck,  and  lower  extremities. 

So  long  as  the  line  of  gravity  falls  within  the  area 

of  the  feet,  the  muscular  effort  required  is  so  slight 

3 


34  Maidenhood. 

that  it  is  little  more  than  the  tonicity  contained  in 
all  living  muscle.  The  greater  the  displacement 
of  the  line  of  gravity,  the  greater  the  muscular 
effort  required  to  maintain  the  equilibrium  of  the 
body.  Up  to  a  certain  extent,  exercising  the  muscle 
develops  the  strength  and  size  of  the  muscle.  On 
the  other  hand,  when  a  muscle  within  the  body  is 
unused,  it  wastes;  when  used  within  certain  limits, 
it  grows.  But  when  the  corset  splint  is  applied  to 
the  body  of  the  young  girl,  it  supplants  the  func- 
tions of  the  abdominal  and  back  muscles,  which 
is  to  hold  the  trunk  erect,  and  these  muscles  gradu- 
ally grow  weak  and  waste.  And  so  the  liability 
to  the  various  spinal  curvatures  is  increased. 

The  original  object  of  the  corset  was  to  give 
greater  prominence  to  the  hips  and  abdomen.  But 
fashions  change!  In  "the  French  figure"  or 
straight-front  corset  now  in  vogue  the  pelvis  is 
tilted  forward,  producing  a  sinking  in  of  the  abdo- 
men and  a  marked  prominence  of  the  hips  and 
sacrum,  necessitating  a  compensatory  curve  of  the 
spine  which  increases  the  curvature  forward  at 
the  small  of  the  back  —  a  deformity  which,  a  few 
years  ago,  women  were  going  to  orthopedic  sur- 
geons to  have  corrected.  In  this  attitude  the  line 
passing  through  the  centre  of  gravity  strikes  the 
heels,  the  knees  are  hyper-extended,  and  the  muscles 
of  the  calves  and  thighs  are  rendered  tense. 


Hygiene  of  Puberty.  35 

By  interfering  with  the  muscular  development 
and  digestion,  the  girl  is  very  apt  to  become  angular, 
flat-chested,  anemic,  and  to  have  a  muddy  com- 
plexion. And  so  the  corset  really  defeats  the  object 
for  which  it  was  put  on  —  that  of  giving  the  girl 
a  good  figure  and  enhancing  her  beauty. 

There  is  no  objection  to  girls  wearing  any  of  the 
various  forms  of  hygienic  waists  now  on  the  market. 

Shoes. — The  feet  are  the  part  of  the  body  to  come 
in  contact  with  the  greatest  degree  of  cold,  whether 
on  the  floor  of  the  house  or  the  pavement  of  the 
street.  Hence  it  is  a  matter  of  prime  importance 
to  the  entire  body  that  the  feet  should  be  properly 
clad. 

The  thick-soled,  flat-heeled  shoes  which  became 
popular  with  bicycling  and  golf  are  most  hygienic, 
and  it  is  highly  desirable  that  this  style  of  shoe 
should  be  adhered  to  for  outdoor  exercise. 

Underwear. — In  our  cold  and' changeable  climate 
the  most  suitable  undergarment  is  the  "  combina- 
tion "  woolen  undersuit,  which  reaches  from  neck 
to  ankles  and  has  long  sleeves.  Much  greater 
warmth  is  afforded  when  the  undersuit  is  moderately 
tight  fitting.  Such  a  suit  should  be  worn  the  entire 
year,  the  grade  of  weight  being  adapted  to  the 
season. 

Nutrition. — The  nutrition  of  the  body  is  depend- 
ent on  the  food  supply,  digestion  and  excretion. 


36  Maidenhood. 

The  growing  girl  should  eat  more  than  the  adult 
woman,  because  of  her  more  active  life  and  of  the 
fact  that  the  food  which  she  takes  must  not  only 
replace  the  worn-out  material  of  the  body,  but  also 
provide  new  material  needed  for  growth.  Insuffi- 
cient food  and  food  of  defective  quality  and  com- 
position work  proportionately  for  more  harm  dur- 
ing the  growing   age. 

The  full  adult  weight  is  not  attained  before  the 
twenty-fifth  year.  When  the  final  growth  of  the 
body  and  development  of  the  vital  organs  is  com- 
pleted, the  function  of  food  is  simply  to  replace 
waste  with  new  material  and  to  furnish  material 
for  the  development  of  force. 

Diet. — The  diet  should  be  a  mixed  one,  consisting 
of  the  various  kinds  of  fresh  meats,  fish,  milk,  eggs, 
poultry,  vegetables,  fruit,  and  fat  in  the  shape  of 
cream,  butter,  and  the  fat  of  beef  and  mutton. 
Animal  food  improves  the  condition  of  the  muscles, 
which  are  made  firmer  than  they  would  be  through 
a  vegetable  diet.  Meat  in  general  has  a  more  stim- 
ulating effect  upon  the  system  and  is  more  strength- 
ening than  vegetable  food,  and  it  gives  rise  to  a 
sensation  of  energy  and  activity.  The  common 
estimate  is  that  meat  should  occupy  one- fourth  and 
vegetable  food  three-fourths  of  a  mixed  diet. 

Common  salt  in  moderate  quantity  is  essential, 
but  all  highly  spiced  or  seasoned  foods  should  be 


Hygiene  of  Puberty.  37 

avoided,  also  pickles  and  vinegar.  All  "  sweets  " 
are  harmful,  because  they  destroy  the  appetite  for 
other  things  and  upset  the  digestion.  Tea  and 
coffee  should  be  tabooed,  as  well  as  all  alcoholic 
beverages. 

Good  digestion  depends  for  the  most  part  on 
serving  the  meals  at  the  same  hour  every  day,  eat- 
ing leisurely,  and  masticating  the  food  well.  There 
is  a  great  tendency  on  the  part  of  the  school  girl 
to  sleep  late  in  the  morning,  then  "  bolt  "  her  break- 
fast in  order  to  get  to  school  in  time.  Nothing 
could  be  more  pernicious  to  the  digestion,  unless 
it  is  the  eternal  nibbling  of  candy. 

A  healthy  girl  needs  nothing  between  meals.  A 
delicate  girl  will  be  the  better  for  a  glass  of  milk 
in  the  middle  of  the  morning  and  at  bed-time;  or 
pure  beef  juice  may  be  given  instead. 

Water. —  Water  is  needed  to  keep  the  kidneys 
properly  flushed.  The  amount  of  urine  secreted 
during  the  twenty-four  hours  should  be  three  pints. 
Of  course  it  will  be  less  than  this  if  the  quantity 
of  water  is  insufficient.  In  addition  to  the  urine 
about  ten  ounces  of  water  are  lost  from  the  surface 
of  the  lungs,  and  eighteen  ounces  from  the  skin, 
making  a  total  of  about  five  pints;  and  this  quan- 
tity of  water  must  be  taken  daily  in  order  to  main- 
tain the  equilibrium  of  the  body.  The  solid  food 
of  a  mixed  diet  contains  from  fifty  to  sixty  per 


38  Maidenhood. 

cent,  of  water,  so  that  about  twenty-five  ounces  of 
water  are  taken  into  the  system  daily  as  an  integral 
part  of  the  food.  In  addition,  three  pints  more 
should  be  taken  as  plain  water.  The  bladder  acts 
as  a  reservoir  for  the  urine,  and  should  be  emptied 
at  least  three  or  four  times  a  day. 

Constipation. — In  order  to  keep  the  digestive  sys- 
tem in  good  condition,  the  refuse  matter  which 
collects  in  the  lower  bowel  must  be  evacuated  every 
day.  And  in  order  to  secure  this  regular  bowel 
movement,  regularity  in  the  time  of  going  to  the 
toilet  is  a  prime  necessity.  And  now  is  the  time 
when  the  habits  of  a  lifetime  are  being  formed. 
If  a  tendency  to  constipation  exists,  it  can  almost 
always  be  overcome  by  increasing  the  amount  of 
fruit  and  vegetables  eaten,  also  by  eating  cracked 
wheat,  oatmeal,  corn  and  graham  bread;  all  of 
which  increase  the  peristaltic  action  of  the  intes- 
tines. The  small  amount  of  water  taken  by  girls 
and  women  is  another  fertile  source  of  constipation. 

School  Life. — When  it  is  considered  that  fully 
one-half  of  the  girl's  waking  hours  are  spent  in 
school  or  in  study  preparing  for  school,  it  becomes 
evident  that  the  girl's  attitude  at  her  desk  should 
be  the  correct  one.  The  malpositions  at  the  desk 
are  the  most  frequent  cause  of  lateral  curvatures, 
round  shoulders,  and  flat  chests.  And  these  deform- 
ities are  more  common  in  girls  than  they  are  in  boys. 


Hygiene  of  Puberty.  39 

The  common  faults  of  the  desk  and  seat  leading 
to  these  malpositions  are  unsuitable  shape  of  the 
back  of  the  seat,  too  great  a  distance  between  the 
seat  and  the  desk,  and  the  incorrect  slope  of  the 
desk. 

The  edge  of  the  desk  should  slightly  project  over 
the  edge  of  the  chair.  The  top  of  the  desk  should 
incline  downward  about  ten  degrees  toward  the 
student,  and  be  low  enough  to  allow  the  forearm 
to  rest  on  it  without  raising  the  shoulder.  The 
seat  should  be  sufficiently  deep  to  support  almost 
the  entire  thigh,  and  close  enough  to  the  floor  to 
allow  the  soles  of  the  feet  to  rest  firmly  on  it.  The 
back  of  the  chair  should  be  arched  so  as  to  support 
the  hollow  of  the  back,  and  should  reach  just  above 
the  lower  part  of  the  shoulder-blades,  and  so  make 
it  easy  and  comfortable  for  even  a  weakly  child 
to  sit  upright. 

If  the  seat  is  too  high,  the  feet  do  not  rest  on 
the  floor,  and  so  the  girl  does  not  get  the  proper  aid 
from  the  legs  and  feet  to  maintain  an  erect  position. 
If  the  desk  is  too  high,  the  elbow  can  rest  on  it 
only  by  curving  the  spine  and  raising  the  shoulder. 
The  work  is  brought  too  close  to  the  eyes  and 
causes  extra  strain.  If  the  desk  is  too  low,  the 
child  stoops  over  it  and  becomes  round-shouldered, 
and  there  is  a  tendency  to  become  short-sighted. 

The  pupil  should  sit  erect  with  the  weight  equally 


40  Maidenhood. 

borne  by  both  buttocks;  the  legs  should  be  straight 
before  the  trunk,  and  the  feet  firmly  resting  on  the 
floor.  The  book  should  be  held  about  twelve  inches 
from  the  eyes. 

Spinal  Curvatures. — It  should  be  distinctly  borne 
in  mind  that  lateral  curvature  of  the  spine  is  a 
distortion  of  growth.  The  deformity  appears  and 
is  developed  during  the  growing  years.  It  is  more 
common  in  girls  than  in  boys,  for  two  reasons :  that 
at  the  age  when  lateral  curvature  is  first  seen,  girls 
grow  more  rapidly  than  boys;  and  their  muscular 
system  is  less  well  developed. 

In  most  early  cases  the  faulty  attitudes  are  clearly 
the  result  of  muscular  weakness.  The  growth  in 
size  has  not  been  accompanied  by  a  corresponding 
development  of  the  muscles.  This  condition  is  most 
frequently  met  with  in  rapidly  growing  girls,  and  it 
is  one  of  the  most  common  causes  of  lateral  curva- 
ture. In  these  cases  proper  gymnastics  are  indi- 
cated, but  they  should  be  prescribed  and  carried  out 
with  much  care. 

It  is  upon  the  erectness,  suppleness,  and  strength 
of  the  spinal  column  that  most  of  the  power  and 
grace  of  the  body  depend. 

Lack  of  ventilation  is  a  fertile  cause  of  headache, 
anemia  (or  an  impoverished  condition  of  the  blood 
in  iron  and  oxygen),  and  dyspepsia.  All  these  are 
rare  before  but  common  after  twelve  years  of  age. 


Hygiene  of  Puberty.  41 

Exercise. — In  physical  culture  the  object  aimed  at 
should  be  the  symmetrical  development  of  all  the 
muscles  of  the  body.  Hence  the  necessity  for  bring- 
ing every  individual  muscle  into  play,  at  first  for  its 
development,  and  later  for  its  maintenance. 

The  tendency  of  almost  all  forms  of  exercise  is  to 
develop  some  portion  of  the  body  at  the  expense  of 
the  rest.  The  most  perfect  form  of  exercise  is 
therefore  that  one  which  will  most  nearly  call  into 
play  all  the  muscles  of  the  body. 

Walking. — Walking  is  the  only  form  of  exercise 
which  may  be  said  to  be  universal.  In  walking  the 
muscles  of  the  chest  get  little  exercise,  and  those 
of  the  spine  and  abdomen  even  less.  In  walking 
the  arms  should  swing  easily  at  the  sides,  both 
from  a  physiological  and  an  esthetic  point  of  view. 
If  the  girl  is  weak  or  is  unaccustomed  to  take  any 
exercise,  the  guide  for  the  amount  of  exercise  taken 
at  any  one  time  must  be  this :  At  the  first  sense  of 
fatigue,  stop  at  once  and  rest,  otherwise  positive 
harm  instead  of  good  may  be  accomplished.  The 
girl  who  depends  on  walking  for  her  outdoor  exer- 
cise should  walk  at  least  three  miles  every  day,  and 
walk  at  the  rate  of  three  miles  an  hour. 

After  acquiring  as  great  a  walking  speed  as  is 
consistent  with  a  graceful  and  easy  carriage,  the 
running  exercise  should  be  begun,  gradually  increas- 
ing the  distance,  but  not  the  rate  of  speed. 


42  Maidenhood. 

In  exercising,  all  tight  clothing  about  the  neck, 
chest,  and  waist  must  be  removed.  Pure  air  and 
full  breathing  are  required  during  and  after  exercise. 
Full  breathing  not  only  promotes  the  change  of  air 
in  the  lungs,  but  also  quickens  the  functions  of  the 
circulation  and  digestion.  Eating  must  be  avoided 
shortly  before  or  shortly  after  any  considerable  ex- 
ercise, as  it  impairs  digestion. 

Running. — Running  is  the  best  exercise  for  de- 
veloping the  breathing  capacity.  While  brisk  walk- 
ing is  allowable,  fast  running  is  not.  The  rule  for 
running  is  to  begin  slowly,  run  moderately  for  per- 
haps fifty  feet,  then  increase  the  speed  gradually; 
but  in  running  for  exercise,  never  speed  to  the 
utmost.  A  five-mile  gait  is  quite  sufficient.  The 
run  should  be  closed  with  the  same  moderation  with 
which  it  was  begun,  and  the  girl  should  never  stop 
short,  as  this  sudden  arrest  of  action  gives  a  most 
undesirable  shock  to  the  heart. 

In  beginning  to  take  any  form  of  exercise  the 
intensity  and  duration  of  the  movements  practiced 
must  be  increased  very  gradually,  or  positive  harm 
instead  of  good  will  be  done.  As  soon  as  fatigue 
is  appreciable,  the  exercise  should  be  discontinued 
and  at  once  be  followed  by  complete  rest.  Rapid 
respiration,  palpitation  or  dizziness,  headache,  the 
face  becoming  pale  or  pinched  or  flushing  suddenly, 
a  feeling  of  great  heat  or  excessive  perspiration,  are 


Hygiene  of  Puberty.  43 

all  danger  signals  showing  that  the  exercise  has 
already  been  carried  too  far  and  should  cease  at 
once.  Continued  over-exertion  carried  to  a  point 
of  exhaustion  leads  to  an  obstinate  irritability  of  the 
heart  as  well  as  to  organic  lesions. 

Mountain-climbing,  rowing,  and  bicycling  call 
into  play  almost  all  the  muscles  of  the  body.  Of  all 
the  outdoor  exercises  for  girls,  swimming  is  one  of 
the  most  perfect.  It  not  only  calls  into  vigorous 
action  most  of  the  muscles  of  the  body,  but  spares 
many  of  those  muscles  that  are  so  commonly  over- 
worked, the  most  of  the  work  being  performed  by 
muscles  that  are  so  little  used  as  to  have  become 
flabby  and  weak. 

Swimming  and  sea-bathing  must  be  avoided  by 
girls  who  have  weak  hearts  and  in  whom  the  reac- 
tion after  a  plunge  into  cold  water  is  never  estab- 
lished; also  by  girls  with  heart  disease  or  kidney 
disease. 

The  principal  outdoor  games  are  croquet,  archery, 
golf,  tennis,  cricket,  foot-ball,  and  base-ball.  Of 
these,  croquet  is  the  mildest,  and  is  for  that  reason 
a  good  beginning  exercise.  Croquet,  archery,  golf, 
and  tennis  are  all  defective  in  that  they  cause  a 
greater  development  of  the  right  than  of  the  left 
side  of  the  body. 

As  the  greater  majority  of  these  outdoor  exercises 
can  only  be  indulged  in  for  seven  months  of  the 


44  Maidenhood. 

year,  they  should  be  supplemented  by  exercises  in 
the  gymnasium  for  the  remaining  five  winter 
months. 

There  should  be  the  greatest  variety  possible  in 
the  kinds  of  exercise  taken,  not  only  to  develop  the 
body  symmetrically,  so  as  to  obtain  strength,  vigor, 
grace,  celerity,  and  accuracy  of  movement,  but  also 
because  there  is  no  such  potent  cause  of  fatigue  as 
monotonous  repetition  of  the  same  act,  whether  phy- 
sical or  mental. 

It  has  been  repeatedly  proven  that  physical  de- 
terioration can  be  overcome  by  exercise,  and  that  by 
so  doing  the  mental  capacity  is  greatly  increased. 


CHAPTER  III. 

ANATOMY  OF  THE  FEMALE 
GENERATIVE  ORGANS. 

The  Vulva;  the  Hymen;  Condition  of  the  Hymen 
as  a  Proof  of  Virginity;  the  Bladder;  Vagina; 
Uterus;  Respiratory  Movements  of  the  Uterus; 
Fallopian  Tubes;  Ovaries. 

"He  that  respects   himself  is  safe   from  others; 
He   wears  a  coat  of  mail   that  none  can   pierce." 

— Longfelww. 

The  Vulva. — The  female  generative  organs  con- 
sist of  three  groups  —  the  external,  the  intermediate, 
and  the  internal.  The  vulva,  or  external  generative 
organs,  comprises  all  those  organs  which  are  ex- 
ternal to  the  body. 

The  vulva  is  pierced  by  two  openings,  the  smallest 
and  most  anterior  of  which  is  the  external  opening 
of  the  urethra,  or  excretory  duct  of  the  bladder. 
This  opening  is  surrounded  by  a  slight  eminence 
and  has  a  somewhat  puckered  aspect. 

The  larger  opening  is  the  vaginal  orifice.  In  the 
virgin  this  is  partially  closed  by  the  hymen.  About 
one  inch  back  of  this  is  the  anus,  or  the  external 
orifice  of  the  large  bowel.  This  part  of  the  bowel 
is  known  as  the  rectum. 

45 


46  Maidenhood. 

The  Hymen. — The  hymen  consists  of  a  thin  dup- 
licature  of  mucous  membrane  strengthened  by 
fibrous  tissue,  and  is  stretched  across  the  posterior 
part  of  the  vaginal  orifice,  which  it  partly  occludes. 
Rupture  of  the  hymen  usually,  but  not  always, 
occurs  during  the  first  sexual  intercourse.  In  rare 
cases  it  is  found  intact  at  the  time  of  the  birth  of  the 
first  child.  In  women  who  have  borne  children  the 
vaginal  orifice  is  surrounded  by  small  irregular 
elevations;  these  are  the  remains  of  the  ruptured 
hymen,  but  are  usually  present  only  after  labor  has 
taken  place,  since  the  torn  hymen  is  converted  into 
eminences  as  the  result  of  the  pressure  incident  to 
child-bearing,  and  not  to  coitus. 

The  Condition  of  the  Hymen  as  a  Proof  of  Vir- 
ginity.— Formerly  much  stress  was  laid  on  the  con- 
dition of  the  hymen  as  a  proof  of  virginity.  The 
hymen  tightly  closed,  barely  admitting  the  tip  of 
a  small  index-finger,  is  positive  evidence  of  vir- 
ginity. But  the  hymen  may  lose  its  tone  by  a  local 
catarrhal  condition  or  by  a  general  muscular  relax- 
ation; it  may  then  become  so  relaxed  that  the  only 
positive  evidence  rendered  by  the  intact  hymen  is 
that  the  woman  has  not  borne  a  child. 

In  a  paper  on  the  preservation  of  the  hymen,  Dr. 
Hannah  M.  Thompson  writes :  "  Further,  if  the 
hymen  was  intended  as  a  guarantee  of  moral  char- 
acter, and  for  moral  protection,  either  of  man  or 


Anatomy  of  the  Female  Generative  Organs.         47 

woman,  would  we  not  have  some  reason  for  reflect- 
ing on  the  wisdom  and  righteousness  of  a  Creator 
who  has  failed  to  make  equal  provision,  and  to  give 
a  like  guarantee  of  an  uncorrupted  manhood?  As 
physicians,  we  know  too  well  that  where  one  woman 
enters  the  marriage  relation  tainted  in  body  there 
are  thousands  of  men  reeking  with  disease;  and 
there  is  no  demonstrable  test  to  distinguish  these, 
no  proof  for  the  young  woman  of  the  virginity  or 
virtue  of  the  young  man." 

The  Bladder. — The  female  bladder  is  relatively 
broad  and  capacious,  and  is  also  highly  distensible. 
When  the  bladder  is  allowed  to  become  overdis- 
tended,  it  is  carried  backward  and  tends  to  cause 
a  backward  displacement  of  the  uterus.  The 
urethra,  or  excretory  duct  of  the  bladder,  is  about 
an  inch  and  a  half  long,  and  lies  firmly  imbedded 
in  the  anterior  vaginal  wall. 

The  Vagina. — The  intermediate  organ  is  the  va- 
gina. This  is  a  musculo-membranous  canal  which 
connects  the  external  with  the  internal  organs  of 
generation.  The  vagina  lies  in  relation  with  the 
bladder  and  the  urethra  in  front,  and  with  the  rec- 
tum behind.  The  vagina  is  sufficiently  distensible 
to  allow  of  the  passage  of  so  large  a  body  as  the 
child. 

The  Uterus. — The  internal  organs  of  generation 
are  the  uterus,  the  ovaries,  and  the  Fallopian  tubes. 


48  Maidenhood. 

Of  these,  the  ovaries  and  the  uterus  are  the  essential 
female  organs  of  generation.  The  virgin  uterus 
is  a  small,  hollow,  muscular  organ,  somewhat  pear- 
shaped,  whose  cavity  is  about  one  and  a  half  inches 
deep.  The  uterus  is  divided  by  a  natural  constric- 
tion into  a  body  and  a  neck.  The  neck,  or  cervix, 
is  somewhat  spindle-shaped,  and  has  a  canal  run- 
ning through  its  center  which  opens  by  a  small  aper- 
ture —  the  so-called  external  orifice, —  into  the  va- 
gina. In  the  virgin  uterus  the  apposition  of  the 
anterior  and  posterior  walls  reduces  the  cavity  to 
little  more  than  a  longitudinal  cleft.  With  the 
advent  of  old  age  the  whole  organ  suffers  marked 
atrophy. 

The  uterus  is  situated  in  the  middle  of  the  pelvic 
cavity,  between  the  bladder  and  the  lower  bowel. 
It  is  held  in  place  by  broad  elastic  bands  which  go 
to  different  sides  of  the  pelvis;  it  is  also  in  part 
supported  by  the  structures  below  and  above  it.  But 
so  loosely  is  the  uterus  held  that  it  is  easily  pushed 
about  —  as,  for  instance,  by  a  full  bladder  or  a 
packed  bowel.  And  persistently  allowing  the  blad- 
der to  become  overfull,  and  failure  to  have  a  daily 
evacuation  of  the  bowels,  are  prolific  sources  of 
displacements  of  the  womb. 

Respiratory  Movements  of  the  Uterus. —  When 
no  constrictions  are  placed  about  the  waist,  the 
uterus  moves  freely  up  and  down  with  every  res- 


Anatomy  of  the  Female  Generative  Organs.         49 

piration.  So  distinctly  and  with  such  regularity 
do  these  movements  take  place  that  an  operator  by 
watching  the  movements  of  the  uterus  can  tell  the 
effect  that  the  anesthetic  is  having  on  the  patient's 
breathing.  These  so-called  respiratory  movements 
play  a  very  important  role  in  the  circulation  of  the 
uterus,  and  in  the  return  of  the  venous  blood  to  the 
heart. 

Anything  which  interferes  with  these  movements, 
as  the  use  of  corsets,  or  of  tight  bands  around  the 
waist,  prevents  the  free  return  of  the  venous  blood. 
The  uterus  becomes  congested,  and  through  the 
constant  abnormal  weight  of  the  organ  itself,  as 
well  as  the  pressing  down  upon  it  from  above  of 
the  superincumbent  organs,  the  uterus  is  pushed 
down  below  its  normal  position,  the  ligaments  whose 
duty  it  is  to  hold  it  up  become  relaxed,  and  the 
unhappy  woman  suffers  all  the  agonies  that  are 
attendant  on  the  "  falling  of  the  womb."  For  this 
reason  the  disorder  is  frequently  met  with  in  women 
who  have  never  borne  children  as  well  as  in  those 
who  have. 

The  Fallopian  Tubes. — The  Fallopian  tubes  ex- 
tend from  the  upper,  rounded  angles  of  the  uterus, 
within  and  along  the  free  margin  of  the  broad  liga- 
ments, for  a  distance  of  about  two  inches,  to  the 
vicinity  of  the  ovaries,  where  each  one  terminates 
in  a  funnel-shaped  orifice  surrounded  by  a  series 


50  Maidenhood. 

bf  fringed  processes.  The  lumen  of  the  tube  is 
narrowest  at  its  inner  end,  where  it  opens  into  the 
cavity  of  the  uterus  by  a  minute  orifice  which 
scarcely  admits  a  bristle;  the  diameter  of  the  canal 
gradually  increases  until  it  reaches  its  ovarian  ex- 
tremity. The  mucous  lining  of  the  tube  is  clothed 
by  a  single  layer  of  hair-like  epithelium,  whose 
current  sweeps  from  the  ovarian  toward  the  uterine 
end  of  the  tube;  and  it  is  these  movements  which 
propel  the  ovum  from  the  ovary  to  the  uterus. 

The  Ovaries. — The  ovaries  are  two  small  bodies 
of  an  almond  shape,  and  lie  on  either  side  of  the 
uterus.  The  bulk  of  the  entire  organ  consists  of 
connective  tissue,  in  which  lie  imbedded  the  Graafian 
follicles  or  ovisacs,  in  which  the  ova  are  contained. 
These  follicles  or  ovisacs  are  minute  cells  which 
are  packed  immediately  beneath  the  surface,  where 
they  occur  in  all  stages  of  development.  With  the 
increase  in  size  which  accompanies  their  develop- 
ment the  follicles  pass  toward  the  surface,  where 
they  form  a  distinct  projection,  and  at  this  point  will 
occur  the  final  rupture  of  the  sac  and  the  escape 
of  the  ovum.  It  is  supposed  that  the  ovum  is  grasped 
by  the  fringe-like  extremity  of  the  Fallopian  tube 
and  is  carried  through  it  by  the  movements  of  the 
ciliary  epithelium  to  the  uterus. 

The  formation  of  new  follicles  continues  only  for 
a  short  time  after  birth,  when  the  Graafian  follicles 


Anatomy  of  the  Female  Generative  Organs.         51 

are  the  most  numerous ;  the  entire  number  contained 
within  the  ovaries  of  the  child  being  estimated  at 
over  70,000.  In  view  of  the  unquestionably  large 
number  of  follicles  in  very  young  ovaries,  and  the 
relatively  small  number  of  ova  which  reach  maturity, 
the  degeneration  of  many  follicles  after  reaching 
a  certain  degree  of  development  seems  certain. 


Llti 
COLLEGE  or  vTKl 

PHYSICIANS  ix  SUKGlEONi 


CHAPTER  IV. 

PHYSIOLOGY  OF  THE  FEMALE 
GENERATIVE  ORGANS. 

Ovulation;  Etiology  of  Menstruation;  Uterine 
Nerve-supply;  the  Function  of  the  Uterus;  Stages 
of  the  Menstrual  Cycle;  Average  Duration  of  the 
Menstrual  Flow;  Character  of  the  Flow;  Rela- 
tion of  Ovulation  to  Menstruation;  the  Menstrual 
Wave;  Definition  of  Menstruation;  Premonitory 
Symptoms  of  the  F4ow;  Hygiene  of  Menstruation. 

"Toil  and  grow  strong;  by  toil  the  flaccid  nerves 
Grow  firm,  and  gain  a  more  compacted  tone." 

— Armstrong. 

Ovulation. — At  birth  the  formation  of  the  ova  is 
nearly  completed ;  the  production  of  new  cells  prob- 
ably ceases  after  the  second  year.  The  ovaries  of 
the  child  of  two  years  contain,  therefore,  the  full 
quota  of  ova,  although  the  vast  majority  of  these 
cells  always  remain  immature  and  undeveloped. 
While  it  is  probable  that  a  variable  number  of  the 
immature  ova  undergo  partial  development  before 
puberty,  yet  the  advent  of  sexual  maturity  at  that 
time  marks  the  establishment  of  the  regular  devel- 
opment of  the  Graafian  follicles  and  their  contained 

52 


Physiology  of  the  Female  Generative  Organs.       53 

ova,  accompanied  by  the  attendant  phenomena  of 
menstruation. 

During  the  entire  child-bearing  period,  or  from 
about  the  age  of  fifteen  to  forty-five  years,  the  devel- 
opment of  the  Graafian  follicles  and  the  discharge 
of  the  ova  are  continually  taking  place.  The  libera- 
tion of  the  ova  usually  takes  place  at  definite  times, 
which  in  general  coincide  with  the  menstrual  epochs, 
one  or  more  ova  being  set  free  at  each  period ;  but 
this  is  by  no  means  invariable. 

The  ripe  human  ovum  or  germ  cell  is  a  spheric 
cell,  about  0.2  mm.  in  diameter,  consisting  of  gran- 
ular protoplasm,  in  which  lies  a  nucleus  which  con- 
tains the  germinal  spot.  The  proper  cell-wall  is 
a  structure  of  great  delicacy,  outside  of  which  is  a 
secondary  envelope. 

Menstruation. — The  etiology  of  menstruation  has 
been  variously  explained  at  different  epochs.  The 
chief  theories  have  been  that  of  plethora,  and  the 
ovulation,  the  tubal,  and  the  nerve  theories. 

First,  the  Theory  of  Plethora. — From  the  time  of 
Hippocrates  to  1835  tne  theory  prevailed  that  in  the 
female  body  the  formation  of  blood  is  sufficiently 
rich  to  provide  every  four  weeks  for  an  overflow 
of  the  same,  the  evacuation  of  which  becomes  a 
necessity.  It  was  believed  that  this  excess  of  blood 
depended  on  an  excess  of  formative  power  in  the 
woman. 


54  Maidenhood. 

Second,  the  Ovulation  Theory. —  This  was  dis- 
tinctly formulated  about  1845.  I*  construed  the 
menstrual  hemorrhage  as  a  subsidiary  phenomenon, 
entirely  dependent  on  the  periodic  dehiscence  of 
ovules.  The  changes  supposed  to  take  place  in  the 
Graafian  follicles  at  each  menstrual  period  were 
believed  to  involve  a  peculiar  expenditure  of  nerve 
force,  which  was  so  much  dead  loss  to  the  individ- 
ual life  of  the  woman.  The  growth  of  the  Graafian 
vesicle  and  its  contained  ovum  was  supposed  to 
cause  an  irritation  of  the  nerves  of  the  ovary,  which 
was  reflected  to  the  entire  nervous  system.  The 
gradual  accumulation  of  this  irritation  finally  caused 
a  reflex  action  which  determined  an  afflux  of  blood 
to  the  uterus  and  ovaries,  which  constitutes  the 
catamenial  flow. 

The  ovulation  theory  was  refuted  by  the  follow- 
ing facts :  Ovulation  may  and  does  occur  without 
menstruation ;  women  who  have  never  menstruated 
may  conceive;  conception  may  occur  during  lac- 
tation, without  the  menses  having  returned  since  the 
last  parturition ;  children  at  birth  have  many  ovules 
contained  within  the  ovaries ;  ovulation  may  persist 
for  a  time  after  the  menopause,  and  even  pregnancy 
has  occurred,  although  very  rarely  after  this  time; 
the  menses  may  continue  regularly  after  the  removal 
of  the  ovaries  and  Fallopian  tubes;  this  is  excep- 
tional, and,  as  a  rule,  the  periods  only  continue  for 


Physiology  of  the  Female  Generative  Organs.       55 

two  or  three  years  at  longest. 

Third,  the  Tubal  Theory. — Lawson  Tait  thought 
that  thorough  removal  of  the  tubes  was  far  more 
essential  in  determining  the  menopause,  and  that 
cases  of  periodically  recurring  hemorrhage  after 
the  removal  of  the  ovaries  were  to  be  explained  by 
the  fact  that  the  tubes  had  not  been  sufficiently  re- 
moved. As  an  anatomic  and  surgical  fact,  the  tubes 
can  never  be  wholly  excised  unless  the  upper  part 
of  the  uterus  is  also  amputated. 

Fourth,  the  Nerve  Theory  of  Menstruation. — This 
is  based  upon  the  following  views : 

1.  That  menstruation  is  a  process  directly  con- 
trolled by  a  nerve-center  situated  in  the  lumbar 
region  of  the  spinal  cord. 

2.  That  the  menstrual  impulses  reach  the  uterus 
through  two  sets  of  nerves. 

3.  That  menstruation  is  the  result  of  nerve  irri- 
tation, vascular  congestion,  and  the  subsequent  relief 
of  these  by  hemorrhagic  discharges. 

4.  That  hemorrhage  from  the  uterus  is  the  result 
either  of  a  local  uterine  condition,  or  of  influences 
outside  of  the  uterus  acting  directly  on  the  center. 

5.  That  the  removal  of  the  appendages  arrests 
menstruation  by  preventing  the  propagation  of  uter- 
ine influences  to  the  center. 

Uterine  Nerve  Supply. — One  set  of  nerves  causes 
contraction  of  the  muscular  fibers  of  the  uterus, 


56  Maidenhood. 

while  the  other  set  transmits  impulses  which  bring 
about  its  vascular  engorgement ;  and  they  are  prob- 
ably concerned  in  bringing  about  the  determination 
of  blood  to  the  uterus  and  its  appendages,  which  is 
so  marked  a  feature  of  the  menstrual  process. 

As  the  result  of  long-continued  investigation, 
Johnstone  has  come  to  the  conclusion  that  the  lining 
membrane  of  the  uterus  belongs  to  that  class  of 
organs  whose  function  it  is  to  replace  organic  waste. 
"  Menstruation  is  a  periodic  wasting  away  of  those 
corpuscles  that  are  too  old  to  make  a  placenta." 
He  has  further  found  that,  as  compared  with  the 
uteri  of  very  many  of  the  lower  animals,  the  human 
uterus  is  very  scantily  supplied  with  lymphatics,  and 
the  only  way  to  rid  the  uterus  of  the  overripe,  and 
therefore  consequently  useless,  tissue  is  to  wash  it 
out  through  the  vagina  by  a  blood-stream.  The 
tough  wall  of  the  human  uterus  and  the  increased 
blood-pressure  caused  by  the  erect  position  cause 
the  difference  between  menstruation  in  the  human 
female  and  rut  in  the  lower  animals. 

The  strong  light  of  recent  investigations  has 
necessitated  the  laying  aside  of  many  time-honored 
theories ;  and  as  the  close  of  the  nineteenth  century 
has  seen  the  emancipation  of  the  uterus  from  the 
thralldom  of  the  ovary,  so  we  may  believe  that  the 
twentieth  century  will  find  women  of  such  fine  phy- 
sique as  to  prove  the  error  of  the  popular  fallacy 


Physiology  of  the  Female  Generative  Organs.       57 

that  the  cause  of  woman's  weakness  lies  in  the  per- 
formance of  her  functions. 

The  Function  of  the  Uterus. —  The  function  of 
the  uterus  is  to  provide  a  favorable  place  for  the 
reception  of  the  product  of  conception,  where  it  may 
be  protected  and  nourished  during  the  period  of  its 
development.  The  purpose  of  menstruation  is  to 
keep  the  uterus  in  suitable  condition  for  the  recep- 
tion of  this  product  of  conception  at  any  time.  It 
is  now  known  that  the  menstrual  flow  is  not  the 
whole  of  menstruation,  and  that  the  changes  going 
on  in  the  uterus  are  almost  as  continuous  as  the 
process  of  digestion.  The  whole' of  the  reproduc- 
tive life  of  woman  has  been  divided  into  cycles  of 
twenty-eight  days  each;  these  cycles  have  been  di- 
vided into  four  stages. 

Stages  of  the  Menstrual  Cycle. —  The  first  or 
constructive  stage  is  one  of  preparation  for  the  re- 
ception of  the  ovum.  During  this  stage  the  prepar- 
ing of  a  decidua  takes  place,  or  building  a  nest  for 
the  expected  egg;  there  is  a  swelling  of  the  mucous 
membrane,  an  enlargement  of  the  uterine  glands, 
and  an  increase  in  the  connective  tissue.  It  is 
thought  that  this  stage  lasts  for  one  week;  when 
pregnancy  does  not  occur,  it  is  followed  by  degen- 
erative changes. 

The  second  or  destructive  stage  is  marked  by  de- 
structive changes  which  give  rise  to  the  usual  phe- 


58  Maidenhood. 

nomena  of  the  menstrual  period;  there  is  a  dis- 
charge of  blood,  mucus,  and  disintegrated  mucous 
membrane.  The  actively  growing  cells  of  the  uter- 
ine lining  membrane  undergo  rapid  destructive 
changes,  the  fabric  of  the  half-formed  decidua  tum- 
bles to  pieces,  the  turgid  capillaries  burst  and  pour 
out  the  menstrual  flow,  which  sweeps  away  all  the 
useless  debris.  The  irritation  sets  up  reflex  uterine 
contractions,  and  so  the  blood  is  squeezed  out  of 
the  distended  capillaries  and  washes  away  the  de- 
generated cells. 

The  third  or  reparative  stage,  as  its  name  indi- 
cates, is  one  of  repair,  in  which  by  constructive 
changes  the  epithelial  lining  which  was  thrown  off 
is  replaced  by  new,  which  is  formed  in  from  three 
to  four  days. 

The  fourth  or  quiescent  stage  includes  the  re- 
maining twelve  or  fourteen  days  of  the  menstrual 
cycle,  and  represents  the  quiescent  period  prior  to 
the  initiative  changes  which  mark  the  beginning  of 
the  next  period. 

Average  Duration  of  the  Menstrual  Flow. — The 
average  duration  of  the  menstrual  flow  is  five  days, 
although  the  variations  are  considerable  in  healthy 
women.  A  flow  lasting  any  place  from  two  to 
six  days  is  perfectly  consistent  with  health ;  but  a 
flow  continuing  less  than  two  or  more  than  six  days 
generally   indicates  local  or  general  disease. 


Physiology  of  the  Female  Generative  Organs.       59 

Character  of  the  Menstrual  Flow. — For  the  first 
few  hours,  or  perhaps  for  the  first  day,  the  flow  is 
usually  slight  in  quantity  and  light  in  color;  on 
the  second  and  third  days  the  flow  reaches  its  height, 
and  is  profuse  and  dark,  but  it  should  never  be 
clotted ;  after  this  it  gradually  ceases.  The  amount 
of  the  flow  varies  from  five  to  ten  ounces.  If  less 
than  five  or  six  or  more  than  eighteen  napkins  are 
pretty  well  saturated  through,  the  amount  may  be 
considered  abnormal. 

Relation  of  Ovulation  to  Menstruation. — It  has 
not  yet  been  decided  just  in  what  relation  the  pro- 
cesses of  ovulation  and  menstruation  stand  to  each 
other.  It  is  supposed  that  the  transit  of  the  ovum 
to  the  uterus  occupies  at  least  one  week.  It  has 
been  thought  that  the  decidua  of  a  particular  men- 
strual period  is  related,  not  to  the  ovum  discharged 
at  that  period,  but  to  the  ovum  discharged  at  the 
preceding  period. 

The  menstrual  wave,  or  the  wave  of  "  supplemen- 
tary nutrition,"*  upon  which  the  menstrual  process 
ultimately  depends,  was  first  established  by  Dr. 
Mary  Putnam  Jacobi  in  the  Boylston  prize  essay 
for  1876;  showing  that  menstrual  life  is  associated 
with  a  wave  of  well-marked  vital  energy,  which  man- 
ifests itself  in  a  monthly  fluctuation  of  the  tempera- 

*Dr.  Goodman  and  Dr.  Stephenson  have  since  written 
on  this  subject,  and  the  "wave "  is  often  known  as  the 
Stephenson   wave. 


60  Maidenhood. 

ture  of  the  body,  in  the  daily  amount  of  the  excre- 
tion of  urea  and  of  carbonic  acid,  and  of  the  rate 
and  tension  of  the  pulse.  The  wave  attains  its 
maximum  during  the  week  preceding  menstruation, 
and  slowly  falls  to  its  minimum,  which  is  reached 
the  week  after  menstruation. 

This  wave  indicates  a  periodic  variation  in  the 
bodily  metabolism,  and  is  probably  directly  influ- 
enced by  the  rhythmic  activity  of  the  menstrual 
center.  This  observation  would  seem  to  be  nullified 
by  the  fact  that  the  phenomena  referred  to  have  been 
found  to  occur  in  men  as  well  as  in  women;  and 
that  the  lower  animals  also  seem  to  show  the  same 
periodic  variations.  "  It  is  therefore  evident  that 
the  phenomena  belong  not  to  the  function  of  men- 
struation, but  to  a  general  law  of  vital  energy." 

Definition  of  Menstruation. — Menstruation  may, 
then,  be  defined  as  the  periodic  discharge  of  blood 
from  the  uterus,  accompanied  by  the  shedding  of  tha 
epithelium  of  the  body,  as  well  as  that  of  the  uterine 
glands  near  their  orifices. 

The  sanguineous  discharge  is  due  partly  to  the 
oozing  of  blood  from  the  surfaces  denuded  of  epi- 
thelium, and  partly  to  active  congestion.  The  dis- 
charge from  the  uterus  is  largely  augmented  by 
mucus  secreted  in  increased  quantity  at  this  period 
from  the  enlarged  uterine  glands. 

The  tubes  take  some  part  in  the  process  of  men- 


Physiology  of  the  Female  Generative  Organs.       61 

struation;  their  mucous  membrane  is  swollen,  the 
epithelium  is  shed  in  places,  and  they  are  filled  with 
a  thin  bloody  fluid,  containing  blood-corpuscles  and 
cast-off  epithelium  cells. 

The  menstrual  wave  continues  from  puberty  to 
the  menopause ;  it  is  a  nervous  phenomenon.  Ovu- 
lation is  a  progressive,  non-periodic  process;  it  be- 
gins before  birth  and  continues  till  the  ovarian  tis- 
sue is  atrophied  or  worn  out. 

Premonitory  Symptoms  of  the  Flow. — The  pre- 
monitory symptoms  of  the  monthly  flow  should  not 
be  so  marked  as  to  cause  the  individual  any  dis- 
comfort. The  first  indication  of  the  return  of  the 
period  should  be  the  appearance  of  the  flow.  There 
is  generally  a  feeling  of  abdominal  fulness  with 
some  lassitude,  and  sometimes  slight  headache.  The 
temperature  is  lower  and  the  pulse  is  slower  than  at 
other  times.  This  lowered  tone  of  the  system  is 
an  additional  reason  for  increased  care  against  ex- 
posure in  wet  or  cold  weather. 

Hygiene  of  Menstruation. —  During  the  men- 
strual periods  all  cold  baths  must  be  strictly  pro- 
hibited, whether  tub-baths  or  cold  sponges.  The 
reason  of  this  is  that  the  application  of  cold  -to  the 
surface  causes  a  driving  in  of  the  blood  from  the 
exterior  of  the  body  to  the  internal  organs;  and 
at  the  menstrual  periods  there  is  already  a  congested 
condition  of  the  pelvic  organs,  and  it  must  be  re- 


62  Maidenhood. 

membered  that  congestion  is  the  first  stage  of  in- 
flammation. 

Hot  or  warm  sponge-baths  may  be  taken  through- 
out the  period;  and  the  vulva  should  be  bathed 
with  warm  water  twice  a  day  through  the  entire 
period  of  the  flow,  as  this  not  only  removes  the 
clotted  blood  before  it  decomposes  and  becomes 
the  source  of  irritation,  but  also  removes  other  irri- 
tating matters,  and  prevents  the  nervousness  that 
is  caused  by  a  local  irritation. 

It  is  strange  how  women  who  are  scrupulously 
neat  in  all  other  respects  will  allow  the  smegma  to 
collect  in  and  about  the  vulva;  as  a  matter  of  fact, 
for  the  purpose  of  cleanliness  it  is  much  more  neces- 
sary that  the  external  genitals  should  be  washed 
twice  a  day  with  soap  and  water  all  through  life 
than  that  the  face  should  be  washed  that  often. 

Another  question  which  is  still  sub  judice  is  the 
necessity  for  and  the  frequency  with  which  vaginal 
douches  should  be  taken ;  all  physicians  are  agreed 
that  a  vaginal  douche  taken  immediately  after  the 
menstrual  period  is  beneficial,  as  it  removes  all  the 
debris  of  the  flow,  which  is  sometimes  very  irritat- 
ing. 

Exercise. — A  moderate  amount  of  exercise  should 
be  taken  every  day;  this  is  needed  now  quite  as 
much  as  at  any  other  time,  and  only  good  can  result 
from  it.     And  no  harm  comes  of  a  woman  going 


Physiology  of  the  Female  Generative  Organs.       63 

Out  in  the  rain  or  in  cold  weather;  as  has  been 
shown,  the  menstrual  process  is  going  on  for  a  large 
part  of  the  time,  and  the  flow  is  only  the  external 
appearance,  but  during  the  time  of  the  flow  the 
woman  must  be  unusually  careful  not  to  get  her  feet 
wet  or  to  sit  down  with  damp  clothing  on.  Violent 
exercise  of  all  kinds  is  to  be  prohibited  at  this  time, 
as  dancing,  rides  on  the  bicycle,  gymnastics,  and 
walks  of  over  three  miles.  The  reason  for  this  is 
very  obvious ;  the  uterus  has  now  reached  the  height 
of  its  turgescence,  and  is  heavier  than  at  any  other 
time,  hence  the  danger  that  displacements  or  a  very 
profuse  flow  would  be  caused  by  any  kind  of  violent 
exercise. 

Treatment. — If  the  woman  has  been  so  unfor- 
tunate as  to  get  caught  out  in  a  heavy  rain  so  that 
her  clothes  have  been  wet  through,  or  if  in  the  cold 
weather  she  should  come  into  the  house  thoroughly 
chilled,  the  best  thing  to  do  is  to  take  off  her  wet 
things  as  quickly  as  possible,  be  well  rubbed  down 
with  hot,  rough  towels,  drink  a  cup  of  hot  tea,  go 
to  bed  at  once  and  place  a  hot-water  bag  over  the 
abdomen.  She  should  remain  in  bed  until  the  next 
morning,  to  the  end  that  the  circulation  may  regain 
its  equilibrium  as  quickly  as  possible  by  the  imme- 
diate relief  of  the  pelvic  congestion.  If  this  ex- 
posure should  have  caused  the  sudden  cessation  of 
the  flow,  a  hot  mustard  foot-bath  should  be  taken. 


64  Maidenhood. 

One  tablespoonful  of  mustard  is  used  to  a  gallon 
of  water  as  hot  as  can  be  borne;  the  pail  should 
be  made  as  full  as  can  be  without  running  over,  and 
a  blanket  wrapped  around  the  pail  and  woman,  so 
as  to  cause  a  profuse  perspiration;  this  should  be 
kept  up  for  ten  minutes ;  if  the  water  cools  off,  hot 
water  may  be  added. 


CHAPTER  V. 

THE  ANOMALIES  OF  MENSTRUATION, 

Menorrhagia  and  Metrorrhagia;  Dysmenorrhea; 
Amenorrhea;  Leitchorrhea;  Pruritus  Vulvae. 

"  Defer  not  till  to-morrow  to  be   wise, 
To-morrow's  sun  on  thee  may   never  rise." 

CONGREVE. 

Menorrhagia  and  Metrorrhagia. — By  menorrhagia 
is  meant  an  excessive  or  too  profuse  menstrual  flow ; 
by  metrorrhagia,  a  flow  of  blood  between  the  men- 
strual periods.  Neither  one  constitutes  a  disease 
by  itself,  but  is  a  symptom  of  some  pathologic  con- 
dition. 

It  has  already  been  stated  that  the  excretory  or- 
gans, by  constantly  eliminating  from  the  system  the 
worn-out  material,  keep  the  machine  healthy  and  in 
good  working  order.  Kept  within  natural  limits, 
this  elimination  is  the  source  of  strength  and  health ; 
beyond  these  limits,  the  menstrual  flow  becomes  an 
actual  hemorrhage  that,  by  draining  away  the  life, 
becomes  the  source  of  weakness  and  disease. 

No  physician  would  dare  to  bleed  a  man  or 
woman  once  a  month,  year  in  and  year  out  for  thirty 
5  65 


66  Maidenhood. 

years ;  but,  through  ignorance  or  folly,  this  is  what 
many  girls  do  for  themselves. 

This  excessive  flow,  aside  from  actual  local  dis- 
ease,  is  brought  about  by  excessive  muscular  exer- 
cise during  menstruation;  by  the  use  of  all  stimu- 
lants, whether  alcoholic  beverages  or  quinin;  as 
well  as  by  the  thinness  of  the  blood. 

When  the  flow  is  excessive,  it  must  be  considered 
a  pathologic  condition,  which  needs  the  physician's 
attention.  Rest  in  the  recumbent  position  is  the 
first  essential;  the  diet  must  be  plain  and  unstimu- 
lating,  and  attention  must  be  paid  to  the  condition 
of  the  blood. 

The  general  diseases  which  generally  cause  this 
condition  are  anemia,  Bright's  disease,  malaria,  the 
early  stages  of  tuberculosis,  and  heart  disease. 

The  local  causes  may  be  reflex,  as  powerful  emo- 
tions; or  due  to  local  disease  of  the  uterus  and  its 
appendages,  as  the  various  inflammations  and  dis- 
placements of  the  uterus,  fibroid  tumors,  polypi,  and 
cancer. 

Dysmenorrhea  is  painful  menstruation.  The  most 
frequent  forms  are  due  to  uterine  congestion;  to 
mechanical  causes,  as  a  narrowing  of  the  cervical 
canal,  particularly  at  its  internal  opening,  or  to  a 
constriction  caused  by  the  bending  over  of  the 
uterus  at  the  junction  of  the  body  and  the  neck; 
or  to  ovarian  irritation. 


The  Anomalies  of  Menstruation.  67 

The  pain  varies  in  intensity  from  slight  discom- 
fort to  the  most  intense  uterine  colic,  which  is  ex- 
perienced in  the  lower  part  of  the  abdomen.  In 
severe  cases  the  general  health  becomes  undermined, 
the  nervous  system  gives  way,  and  hysteria  and 
other  disorders  of  the  nervous  system  result. 

The  congestive  variety  usually  occurs  in  patients 
who  have  previously  menstruated  painlessly.  The 
pain  comes  on  suddenly  with  the  flow  and  ceases 
when  the  flow  stops;  it  is  very  severe  and  is  gen- 
erally accompanied  by  a  diminution  or  a  cessation 
of  the  flow.  There  is  severe  headache,  marked 
diminution  in  the  secretion  of  the  kidneys,  and  gen- 
eral restlessness.  The  patient  frequently  experiences 
pain  in  walking,  is  easily  fatigued,  has  leucorrhea 
and  an  irritable  bladder. 

In  ovarian  dysmenorrhea  the  pain  precedes  the 
flow  for  several  days  and  ceases  when  a  free  flow 
is  established.  The  pain  is  of  a  dull  aching  charac- 
ter, and  may  be  felt  on  one  or  both  sides  of  the 
abdomen,  according  as  one  or  both  ovaries  are  in- 
volved. 

Amenorrhea. — In  amenorrhea  the  menstrual  flow 
may  not  appear  for  some  years  after  it  is  normally 
due;  or  the  flow  may  cease  after  some  months  or 
years  of  continuance ;  or  the  flow  may  be  abnormally 
scanty  or  even  absent. 

The  menstrual  flow  is  much  later  in  appearing  in 


68  Maidenhood. 

some  families  than  in  others,  so  that  this  may  be 
considered  as  a  family  idiosyncrasy;  and  if  the  girl's 
health  is  good,  it  need  cause  no  anxiety.  If,  on  the 
contrary,  the  girl  has  severe  headaches,  or  suffers 
in  any  way,  the  physician  should  be  summoned  at 
once,  as  the  absence  of  menstruation  may  be  indica- 
tive of  some  serious  pathologic  condition. 

A  scanty  flow  is  often  indicative  of  thinness  of 
the  blood ;  on  the  other  hand,  serious  anemias  often 
lead  to  profuse  menorrhagias  or  metrorrhagias,  as 
has  already  been  stated.  The  cause  of  the  profound 
anemia  itself  may  be  insufficient  nutrition,  overwork, 
or  lack  of  exercise. 

Scanty  menstruation  is  often  seen  to  occur  in 
fevers,  in  the  later  stages  of  consumption,  in  ad- 
vanced Bright's  disease,  in  malaria,  or  in  any  other 
very  serious  disease.  In  these  cases  it  seems  to 
be  a  conservative  process  on  the  part  of  nature  in 
the  run-down  state  of  the  system.  As  consumption 
progresses  menstruation  generally  ceases  absolutely, 
never  to  return  again;  and  in  this  case  nothing 
should  be  done  to  try  to  induce  a  return  of  the  flow. 

Great  shock  sometimes  causes  a  sudden  cessation 
of  the  flow;  and  sometimes  a  sea- voyage,  followed 
by  the  change  of  habitat,  will  cause  an  obstinate 
form  of  amenorrhea. 

But  it  cannot  be  too  well  understood  that,  after 
the  menstrual  flow  has  been  regularly  established, 


The  Anomalies  of  Menstruation.  69 

it  continues  with  the  greatest  regularity  throughout 
the  child-bearing  period,  unless  the  exposure  to  wet 
or  cold  has  been  sufficiently  severe  to  cause  great 
indisposition  on  the  part  of  the  woman.  In  this 
case  it  is  possible  that,  if  the  exposure  took  place 
just  previous  to  the  time  of  the  expected  flow,  one 
period  may  remain  out.  But  except  in  case  of  se- 
rious illness, —  as  for  example,  typhoid  fever, —  two 
or  more  periods  do  not  fail  to  appear  except  in  the 
case  of  pregnancy. 

Leucorrhea. — Leuchorrhea,  or  "  whites,"  is  a  mu- 
cous or  mucopurulent  discharge  from  the  vagina; 
it  may  be  a  symptom  of  uterine  or  vaginal  disease. 

Immediately  after  the  menstrual  flow  there  is  a 
well-marked  vaginal  secretion  which  is  whitish  in 
appearance;  it  may  be  transparent  or  of  a  milky 
color,  and  is  sometimes  very  acrid.  This  secretion 
may  also  precede  the  flow,  and  there  is  nothing 
abnormal  in  this.  But  any  discharge  occurring  be- 
tween the  periods  sufficient  to  stain  the  clothing  — 
the  so-called  whites  or  leucorrhea  —  is  abnormal, 
and  is  caused  by  an  inflammation  of  the  vagina  or 
the  neighboring  parts.  In  addition  to  the  discharge 
there  is  heat  and  swelling  of  the  parts,  more  or 
less  local  distress,  and  generally  intense  nervousness. 

If  the  disease  is  not  cured,  it  may  become  chronic. 
The  pain,  heat,  and  scalding  disappear,  but  a  copious 
discharge  continues,  and  in  this  stage  the  disease 


jo  Maidenhood. 

may  be  very  obstinate  and  greatly  reduces  the 
strength.  The  constant  drain  breaks  down  the  sys- 
tem, producing  pallor,  debility,  pain  in  the  back, 
palpitation,  indigestion,  and  so  forth. 

The  character  of  the  discharge  in  Ieucorrhea  varies 
considerably,  from  a  whitish  or  mucous  secretion, 
to  a  yellowish  or  mucopurulent  secretion,  and  is 
debilitating  in  proportion  as  it  is  profuse.  It  is  to 
be  remembered  that  this  is  not  in  itself  a  disease, 
but  indicates  a  disease  of  some  of  the  pelvic  organs ; 
and  that  all  such  inflammations  left  to  themselves 
incline  to  grow  worse. 

A  severe  Ieucorrhea  is  generally  attended  with 
frequent  and  finally  painful  micturition;  pain  in 
walking  in  the  lower  part  of  the  abdomen,  which 
may  become  so  severe  as  to  compel  the  patient  to 
go  to  bed. 

Pruritus  Vulvae. — This  is  an  intense  and  persist- 
ent itching  of  the  vulva,  and  is  a  symptom  rather 
than  a  disease.  It  is  not  an  infrequent  result  of 
Ieucorrhea,  the  acrid  discharge  of  the  latter  leading 
to  an  irritation  of  the  parts;  this  causes  rubbing 
of  the  parts  until  a  veritable  inflammation  is  pro- 
duced. 

Other  causes  of  pruritus  vulvae  are :  The  local 
congestion,  such  as  occurs  at  the  menstrual  period, 
or  in  certain  cases  of  pelvic  inflammations,  or  in 
early  pregnancy;    constipation;    sedentary  habits; 


The  Anomalies  of  Menstruation.  71 

congestion  of  the  liver;  incontinence  of  urine,  and 
diabetes.  When  dependent  on  the  latter,  the  malady 
is  most  obstinate  in  yielding  to  treatment.  Indi- 
gestible foods  or  drinks,  the  rubbing  of  the  clothes, 
the  friction  of  walking,  and  the  heat  of  the  bed  act 
as  exciting  causes  in  those  predisposed  to  it. 

The  essential  treatment  here  is  to  at  once  ascertain 
and  remove  the  cause;  aids  in  the  treatment  are 
vaginal  douches  and  cooling  lotions. 


CHAPTER  VI. 

THE  MARRIAGE  QUESTION. 

Herbert  Spencer's  Definition  of  Love;  What  Con- 
stitutes a  Suitable  Husband;  Best  Age  for  Mar- 
riage; Shall  Cousins  Marry?  Contraindications 
to  Marriage;  Do  Reformed  Profligates  Make 
Good  Husbands f  the  Proper  Length  of  Time  for 
the  Engagement ;  the  Right  Time  of  the  Year  to 
Marry;  the  Selection  of  the  Wedding  Day. 

"Well,  Brutus,  thou  art  noble;  yet,   I  see, 
Thy   honourable   mettle   may   be   wrought 
From    that    it    is    disposed:     Therefore,    'tis    meet 
That    noble   minds   keep    ever    with   their    likes. 
For   who   so   firm   that  cannot  be   seduced?" 

— "Julius  Ccesar." 

Herbert  Spencer's  Definition  of  Love. — "  Love  is 
habitually  spoken  of  as  though  it  were  a  simple 
feeling,  whereas  it  is  the  most  compound,  and  there- 
fore the  most  powerful,  of  all  the  feelings.  Added 
to  the  purely  physical  elements  of  it,  are  first  to  be 
noticed  those  highly  complex  impressions  produced 
by  physical  beauty;  around  which  are  aggregated 
a  variety  of  pleasurable  ideas,  not  themselves  ama- 
tory, but  which  have  an  oragnized  relation  to  the 
amatory  feelings.  With  this  there  is  united  the 
complex  sentiment  we  term  affection  —  a  sentiment 

72 


The  Marriage  Question.  73 

which,  as  it  can  exist  between  those  of  the  same  sex, 
must  be  regarded  as  an  independent  sentiment,  but 
one  which  is  here  greatly  exalted.  Then  there  is 
the  sentiment  of  admiration,  respect,  reverence,  in 
itself  one  of  considerable  power,  and  which  in  this 
relation  becomes  in  a  high  degree  active.  There 
comes  next  the  feeling  called  the  love  of  approba- 
tion. To  be  preferred  above  all  the  world,  and 
that  by  the  one  admired  above  all  others,  is  to  have 
the  love  of  approbation  gratified  in  a  degree  passing 
every  other  experience,  especially  as  there  is  added 
that  indirect  gratification  of  it  which  results  from 
the  preference  being  witnessed  by  others.  Further, 
the  allied  emotion  of  self-esteem  comes  into  play. 
To  have  succeeded  in  gaining  such  attachment  from 
and  sway  over  another  is  a  proof  of  power  which 
cannot  fail  to  agreeably  excite  amour  propre.  Yet 
again,  the  proprietary  feeling  has  its  share  in  the 
general  activity.  There  is  the  pleasure  of  possession, 
the  two  belonging  to  each  other.  Once  more,  the 
relation  allows  of  an  extended  liberty  of  action. 
Toward  each  other  a  strained  behavior  is  requisite. 
Around  each  there  is  a  suitable  boundary  that  may 
not  be  crossed;  an  individuality  on  which  none 
may  trespass.  But  in  this  case  the  barriers  are 
thrown  down,  and  the  love  of  unrestrained  activity 
is  gratified.  Finally,  there  is  an  exaltation  of  sym- 
pathies, egotistic  pleasures  of  all  kinds  are  doubled 


74  Maidenhood 

by  another's  sympathetic  participation,  and  the  pleas- 
ures of  another  are  added  to  the  egotistic  pleasures. 
Thus  around  the  physical  feeling  forming  the  nu- 
cleus of  the  whole,  are  gathered  the  feelings  pro- 
duced by  personal  beauty  that  constitutes  simple 
attachments,  of  self-esteem,  of  property,  of  love  of 
freedom,  of  sympathy.  These,  all  greatly  exalted 
and  severally  tending  to  reflect  their  excitements 
on  one  another,  unite  to  form  the  mental  state  we 
call  love.  And  as  each  of  them  is  comprehensive 
of  multidinous  states  of  consciousness,  we  may  say 
that  this  passion  fans  into  immense  aggregate  most 
of  the  elementary  excitations  of  which  we  are  capa- 
ble;  and  that  hence  results  its  irresistible  power." 

What  Constitutes  a  Suitable  Husband. — It  is  de- 
sirable that  the  husband  shall  be  a  few  years  older 
than  the  wife.  Man  is  later  in  coming  to  maturity, 
and  also  retains  his  sexual  powers  considerably 
longer  than  woman;  so  that  for  these  functions  to 
cease  about  the  same  time,  the  wife  must  be  younger 
than  the  husband.  A  difference  of  from  two  to 
five  years  is  best ;  if  the  parties  are  young,  it  is  not 
essential  that  the  husband  should  be  much  the  wife's 
senior,  as  it  is  later  in  life.  The  husband  may  be 
ten  years  older,  but  a  greater  disparity  of  age  than 
this  is  rarely  compatible  with  congeniality  of  tastes 
and  dispositions,  so  essential  to  a  happy  married 
life.     The  woman  who  risks  her  happiness  with  a 


The  Marriage  Question.  75 

man  many  years  younger  than  herself  violates  a 
precept  of  nature. 

The  average  stature  of  the  man  is  about  three 
inches  greater  than  that  of  the  woman,  and  in  the 
physiologic  marriage  any  great  deviation  from  this 
should  be  avoided. 

The  essentials  for  a  happy  marriage  may  be 
summed  up  as  follows :  that  the  parties  shall  be 
of  suitable  age;  that  they  shall  be  physically  well 
mated  and  in  full  sympathy  with  each  other's  views 
of  life,  of  the  same  social  position,  and  of  equal 
education. 

The  Best  Age  for  Marriage. — The  reproductive 
life  begins  with  puberty,  but  maturity  is  not  reached 
before  the  age  of  twenty-one.  It  is  only  then  that 
the  standard  of  development  is  reached  that  is  most 
compatible  with  the  successful  bearing  of  the  grave 
responsibilities  of  wifehood  and  motherhood.  The 
too  early  exercise  of  the  reproductive  functions  leads 
to  increased  suffering  on  the  part  of  the  mother, 
depresses  her  vitality,  and  increases  her  liability  to 
disease.  Statistics  show  that  the  mortality  is  very 
much  greater  where  girls  marry  under  twenty  years 
of  age. 

The  offspring  are  apt  to  be  small  and  ill  devel- 
oped, and  die  in  large  numbers  in  early  life;  only 
a  small  percentage  live  long  and  robust  lives.  In 
France  it  has  been  observed  that  where  the  fear  of 


y6  Maidenhood. 

conscription  has  caused  many  young  people  to  marry 
the  offspring  were  lacking  in  vigor.  Among  the 
offspring  of  immature  parents  there  is  a  larger  pro- 
portion of  idiots,  cripples,  criminals,  scrofulous,  in- 
sane, and  tubercular  than  among  the  children  of 
nubile  parents. 

In  our  climate  women  are  best  fitted  to  become 
wives  and  mothers  between  the  ages  of  twenty-four 
and  twenty-eight  years.  Before  this  age  neither 
their  self-knowledge,  their  knowledge  of  the  world, 
nor  their  experience  is  sufficiently  mature  to  fit  them 
to  wisely  make  the  choice  of  a  companion  for  life, 
or  to  become  mothers.  After  forty,  most  women 
cannot  hope  for  children.  Men  had  better  wait 
until  between  the  ages  of  twenty-seven  and  thirty 
years,  before  they  undertake  the  responsibilities  of 
parenthood. 

Shall  Cousins  Marry? — They  might  if  both  fami- 
lies were  perfectly  healthy;  but  as  few  families  are 
without  some  lurking  predisposition  to  disease,  it 
is  not  well,  as  a  rule,  to  run  the  risk  of  developing 
this  by  too  repeated  unions. 

Contraindications  to  Marriage. —  Young  women 
in  whose  family  there  is  a  distinct  history  of  such 
hereditary  diseases  as  cancer,  tuberculosis,  or  insan- 
ity for  two  generations  back,  should  not  marry  at 
all.  Not  only  is  this  a  fearful  legacy  to  hand  down 
to  their  children,  but  pregnancy  and  child-bearing 


The  Marriage  Question.  JJ 

very  decidedly  favor  the  development  of  these  dis- 
eases. 

Syphilis  in  either  sex  is  a  distinct  bar  to  marriage ; 
first,  the  party  married  is  sure  to  contract  the  dis- 
ease, even  though  it  may  have  been  supposed  to 
have  been  cured.  Fortunately,  the  children  of  such 
marriages  are  generally  still-born;  still,  they  do 
sometimes  live,  and  are  most  pitiable  and  sickly 
objects.  For  any  one  to  marry  under  these  condi- 
tions is  a  crime  against  society,  against  the  State, 
and  against  posterity. 

Women  who  have  serious  forms  of  heart  disease, 
tuberculosis,  or  Bright's  disease  would,  by  becoming 
pregnant,  run  a  serious  risk  of  losing  their  lives 
toward  the  close  of  the  pregnancy  or  at  the  time  of 
their  confinement.  In  case  of  heart  disease,  the  pul- 
monary congestion  that  accompanies  pregnancy,  to- 
gether with  the  encroachment  of  the  pregnant  uterus 
on  the  cavity  of  the  chest,  would  greatly  add  to  the 
embarrassment  of  the  heart's  action. 

In  normal  pregnancy  there  is  some  congestion  of 
the  kidneys;  where  there  is  actual  disease  of  the 
kidneys  prior  to  the  pregnancy,  this  congestion  is 
apt  to  become  so  severe  as  to  threaten  the  woman's 
life.  These  organic  diseases  are  not  to  be  con- 
founded with  functional  diseases  which  are  depend- 
ent on  some  other  cause;  as  palpitation  of  the  heart 
due  to  indigestion,  or  heart  murmurs  dependent  on 


78  Maidenhood. 

the  thin  state  of  the  blood,  or  congestion  of  the 
kidneys  due  to  exposure  to  cold ;  —  all  of  which 
may  be  cured  by  proper  treatment. 

Should  a  woman  with  a  fibroid  tumor  marry,  she 
would  run  a  great  risk  to  her  life;  she  should  have 
the  tumor  removed,  or,  if  this  is  not  possible,  she 
should  give  up  all  thoughts  of  marriage,  since  the 
increased  irritation  and  congestion  consequent  upon 
the  marital  relations  would  tend  to  favor  its  growth. 
Should  pregnancy  ensue,  delivery  might  be  attended 
with  serious  complications,  as  very  difficult  labor, 
postpartum  hemorrhage,  or,  as  these  tumors  have 
but  little  vitality,  and  the  pressure  to  which  they  are 
subjected  during  labor  is  liable  to  cause  their  death, 
disorganization,  sloughing,  and,  as  a  result,  puer- 
peral septicemia. 

Sometimes  there  is  such  a  lack  of  development 
of  the  genital  organs  as  to  prevent  the  woman  from 
having  children. 

Two  persons  with  even  a  slight  tendency  to  the 
same  disease,  either  inherited  or  acquired,  should  not 
intermarry,  even  if  they  are  in  comparatively  good 
health  at  the  time.  Their  offspring  would  be  quite 
sure  to  inherit  their  diseased  tendencies. 

Persons  whose  constitutions  have  been  somewhat 
injured,  but  who  are  not  tainted  with  actual  disease, 
may  rear  children  much  healthier  than  themselves, 
provided  their  own  lives  are  wisely  regulated.     If 


The  Marriage  Question.  79 

they  are  growing  better  all  the  time,  and  are  not 
too  much  broken  in  constitution,  it  may  be  safe  for 
them  to  marry. 

Among  the  Jews  the  physician  is  frequently  con- 
sulted before  matrimonial  alliances  are  contracted. 
This  custom  could  not  but  be  of  universal  benefit; 
many  local  or  general  diseases  would  be  eradicated 
before  marriage,  and  in  this  way  much  suffering 
and  unhappiness  would  be  spared ;  or,  in  other  cases, 
the  patient  would  be  advised  of  the  inadvisability  of 
marriage. 

Do  Reformed  Profligates  Make  Good  Husbands? 
— The  manner  of  life  that  has  been  led  by  this  class 
of  men  is  such  as  to  undermine  their  health,  if  not 
to  have  rendered  them  physical  wrecks.  There  is 
the  overindulgence  in  alcoholic  beverages,  and  per- 
haps, added  to  this,  some  drug  habit.  In  addition 
to  this,  these  men  early  in  their  career  are  apt  to 
become  infected  with  some  of  the  venereal  diseases, 
or  perhaps  with  all  of  them  —  gonorrhea,  syphilis, 
and  so  forth;  and  these  diseases  have  the  horrible 
characteristics  of  becoming  latent.  A  man  who  con- 
tracts this  kind  of  a  disease  can  never  be  really  sure 
that  he  is  cured.  All  venereal  diseases  are  highly 
contagious. 

It  is  now  a  well-established  fact  that  gonnorrheal 
infection  is  not  only  one  of  the  most  common  causes 
of  pelvic  inflammations  in  women,  but  that  these 


80  Maidenhood. 

same  inflammations  are  of  the  most  virulent  types, 
unless  they  are  recognized  and  treated  in  the  early 
stages.  It  is  also  a  well-known  fact  that  a  large 
percentage  of  married  women  suffer  from  this  dis- 
ease.    Sterility  almost  always  results. 

In  the  case  of  a  syphilitic  parent,  one  or  two 
children  may  be  born,  but  the  offspring  is  generally 
sickly  and  diseased.  Inebriety  as  well  as  sexual  ex- 
cessesare  both  well  recognized  as  distinct  forms  of 
disease  accompanied  by  degeneracy  of  brain  tissue. 
It  is  nothing  less  than  criminal  for  such  men  to  have 
children,  since  these  children  would  at  least  inherit 
the  tendency  to  the  same  diseases,  if  they  did  not 
actually  have  them;  there  is  also  a  strong  proba- 
bility of  such  children  being  born  idiots  or  imbeciles. 

It  is  therefore  self-evident  that,  instead  of  a  re- 
formed profligate  making  a  good  husband,  he  must 
make  a  very  diseased  one.  It  has  therefore  been 
suggested  that  the  parents  of  the  prospective  bride 
should  demand  from  the  intended  groom  a  certificate 
of  freedom  from  all  venereal  diseases  by  a  physician 
of  their  own  selection.  Also  that  there  should  be 
legislation  upon  the  subject,  and  that  before  a  man 
is  granted  a  license  of  marriage,  he  should  have  a 
certificate  from  the  health  officer  of  freedom  from 
syphilis,  gonorrhea,  and  tuberculosis. 

The  Proper  Length  of  Time  for  the  Engagement. 
— A  period  not  shorter    than    three    months,  nor 


The  Marriage  Question.  81 

longer  than  one  year,  should  elapse  between  the 
engagement  and  the  marriage. 

There  are  strong  physiologic  reasons  against  long 
engagements :  they  keep  the  affections  and  the  pas- 
sions in  an  excited  and  unnatural  condition,  which 
after  a  time  tends  to  weaken  the  nervous  system 
and  undermine  the  health.  These  evil  consequences 
are  common  to  both  sexes.  It  is  far  better  that  the 
subject  of  marriage  should  not  be  entertained  at  all 
unless  the  circumstances  are  such  that  the  union 
might  with  propriety  be  effected  at  once. 

The  Right  Time  of  the  Year  to  Marry  .—When 
woman  marries  she  enters  upon  a  new  life,  and  a 
very  trying  one.  Extreme  heat  and  extreme  cold 
are  both  very  taxing  to  the  human  economy.  Mid- 
summer and  midwinter  are  therefore  both  objection- 
able, but  especially  the  former. 

The  Selection  of  the  Wedding-day. — This  is  by 
common  consent  left  to  the  bride.  She  should  select 
a  time  about  ten  or  fifteen  days  after  the  end  of  one 
of  her  menstrual  periods,  as  this  is  the  time  of  com- 
parative sterility,  and  it  is  most  desirable  that  the 
first  sexual  relations  should  be  fruitless. 


PART  II -MARRIAGE. 


CHAPTER  VII. 

THE  ETHICS  OF  MARRIED  LIFE. 

The  Wedding  Journey;  the  Ethics  of  Married 
Life;  Shall  Husband  and  Wife  Occupy  the  Same 
Bed?  the  Consummation  of  Marriage;  the  Mari- 
tal Relation;  Times  when  Marital  Relations 
Should  be  Suspended.  ' 

"  If  it  is  possible  to  perfect  mankind,  the  means  of  doing  so  will  be 
found  in  the  medical  sciences." — Descartes. 

The  Wedding-journey. —  The  wedding- journey, 
which  was  formerly  the  cause  of  so  much  discom- 
fort to  both  husband  and  wife,  has  fortunately  gone 
out  of  vogue;  and  in  its  place  has  come  the  retire- 
ment to  a  quiet  country  or  seaside  spot,  away  from 
the  prying  eyes  of  friends.  Thus  the  nervous  strain 
incident  to  sight-seeing  and  travel  is  avoided. 

The  Ethics  of  Married  Life. — It  has  been  said 
that  God  .set  men  and  women  in  pairs  in  order 
that  they  might  perfect  each  other  and  complete  each 
other's  happiness.  The  secret  of  all  true  happiness 
in  life  lies  in  the  spirit  of  altruism;  one  must  be 

82 


The  Ethics  of  Married  Life.  83 

able  to  wholly  forget  herself  and  to  find  her  hap- 
piness in  the  welfare  of  others. 

The  woman  who  exhausts  herself  physically  and 
financially  on  the  preparation  of  her  trousseau  and 
her  wedding  does  her  husband  a  wrong  by  bring- 
ing him  a  wife  who  is  on  the  verge  of  nervous 
prostration. 

The  secret  of  a  happy  married  life  depends  to 
no  small  extent  on  the  very  beginning :  the  relation 
is  so  entirely  new,  and  much  lies  hidden  in  the 
character  of  each  that  was  never  suspected  by  the 
other. 

Between  husband  and  wife  there  must  always  be 
mutual  concessions,  forbearance,  and  sympathy;  a 
mutual  helpfulness  to  attain  all  that  is  best.  This, 
of  course,  implies  that  the  life  of  each  is  an  open 
book  for  the  other  to  read;  that  there  is  an  un- 
reserved exchange  of  thought ;  and  that  no  privilege 
is  claimed  by  the  one  that  would  not  willingly  be 
accorded  to  the  other. 

"  How  many  men,"  says  Balzac,  "  proceed  with 
women  as  the  monkey  of  Cassan  with  the  violin; 
they  have  broken  the  heart  without  knowing  it,  as 
they  have  tarnished  and  disdained  the  jewel  whose 
secret  they  never  understood.  Almost  all  men  are 
married  in  ignorance  of  women  and  of  love.  They 
have  commenced  by  forcing  open  the  doors  of  a 
strange  house  and  have  wished  to  be  well  received 


84  Marriage. 

in  its  salon.  But  the  most  ordinary  artist  knows 
that  there  exists  between  him  and  his  instrument  — 
his  instrument  which  is  made  of  wood  or  ivory  —  a 
sort  of  indefinable  friendship.  He  knows  by  ex- 
perience that  it  has  taken  years  to  establish  this  mys- 
terious rapport  between  an  inert  material  and  him- 
self. He  could  not  have  divined  at  the  first  stroke 
all  its  resources  and  caprices,  its  faults  and  its  vir- 
tues. His  instrument  only  became  a  soul  for  him 
and  a  source  of  melody  after  long  study;  he  only 
came  to  understand  it  as  two  friends  after  the  most 
learned  interrogation. 

"  So  the  world  is  full  of  young  women  who  grow 
pale  and  feeble,  sick  and  suffering.  The  ones  are  a 
prey  to  inflammations  more  or  less  severe ;  the  others 
remain  under  the  dominion  of  nervous  attacks  more 
or  less  violent.  All  these  husbands  have  caused 
their  own  unhappiness  and  ruin.  Never  begin  mar- 
ried life  with  a  rape.  To  demand  of  a  young  girl 
whom  one  has  seen  forty  times  in  fifteen  days  to 
love  you  because  of  the  law,  the  king,  and  justice  is 
an  absurdity. 

"  Love  is  the  union  of  necessity  and  of  sentiment. 
Happiness  in  marriage  is  the  result  of  perfect  un- 
derstanding between  the  spirits  of  husband  and 
wife.  From  this  it  happens  that  in  order  to  be 
happy,  a  man  is  obliged  to  bind  himself  to  certain 
rules  of  delicacy  and  honor.    After  taking  advantage 


The  Ethics  of  Married  Life.  85 

of  the  social  laws  which  consecrate  the  necessity, 
it  is  necessary  to  obey  the  secret  laws  of  nature,  in 
order  to  make  the  sentiments  flourish.  If  a  man 
places  his  happiness  on  being  loved,  it  is  necessary 
that  he  should  love  sincerely ;  nothing  resists  a  veri- 
table passion." 

Shall  Husband  and  Wife  Occupy  the  Same  Bed? 
— Among  civilized  nations  custom  differs  in  this 
regard;  in  Germany,  for  instance,  the  husband  and 
wife  occupy  separate  beds  in  the  same  room;  for- 
merly in  this  country  it  was  almost  the  universal 
custom  for  husband  and  wife  to  occupy  the  same 
bed.  The  current  of  opinion  has  changed  in  this 
respect,  and  it  is  now  considered  in  the  highest  in- 
terests of  both  that  they  shall  occupy  not  only  sep- 
arate beds,  but  separate  rooms;  these  rooms  com- 
municating through  a  door  which  connects  their  re- 
spective dressing-rooms.  This  is  unquestionably  the 
best  arrangement  from  the  hygienic  as  well  as  from 
the  ethical  point  of  view.  Health  requires  that  one- 
third  of  the  time  shall  be  spent  in  sleep;  the  bed 
was  made  for  sleep;  and  the  most  refreshing  sleep 
can  only  be  obtained  by  occupying  the  bed  alone. 
If  two  persons  occupy  the  same  bed  and  one  is  rest- 
less, the  sleep  of  the  other  is  necessarily  disturbed. 
Again,  two  persons  occupying  the  same  bed  neces- 
sitates the  same  hour  for  rising  and  retiring,  which 
is  not  always  convenient  or  agreeable.    Balzac  writes 


86  Marriage. 

on  this  subject :  "  To  put  the  system  of  separate 
bed-rooms  into  practice  is  to  attain  to  the  highest 
degree  of  intellectual  power  and  of  virility.  By  what 
syllogism  man  arrived  at  establishing  as  a  custom 
that  of  man  and  wife  sleeping  together,  a  practice 
so  fatal  to  happiness,  to  health,  to  pleasure,  and 
even  to  self-love,  would  be  curious  to  seek  out."  If 
for  financial  reasons  it  is  not  possible  to  have  sepa- 
rate bed-rooms,  the  German  custom  of  having  sep- 
arate beds  should  be  adopted. 

The  Consummation  of  Marriage. — The  consum- 
mation of  marriage  is  often  attended  with  difficulty 
owing  to  the  rigidity  of  the  hymen ;  this,  if  present, 
must  usually  be  ruptured  before  connection  takes 
place.  Great  gentleness  and  care  must  be  exercised 
by  the  husband  if  it  does  not  readily  yield,  the  use 
of  hot  vaginal  injections  should  be  kept  up  for  sev- 
eral weeks  before  the  trial  is  repeated.  These  usually 
relax  the  parts  very  considerably;  but  if  coitus  is 
still  found  impossible,  it  is  better  to  consult  a  physi- 
cian at  once,  when  a  simple  operation  will  generally 
remove  the  trouble  and  the  woman  is  spared  much 
suffering.  In  no  case  is  any  violence  on  the  part 
of  the  husband  allowable,  as  it  might  produce  ir- 
reparable injuries. 

There  is  always  more  or  less  suffering  on  the  part 
of  the  wife  at  first,  partly  due  to  the  rupture  of  the 
hymen,  and  partly  to  the  forcible  dilatation  of  the 


The  Ethics  of  Married  Life.  87 

vagina  and  she  should  be  allowed  a  sufficient  time 
for  nature  to  repair  these  injuries.  By  so  doing, 
the  constitutional  disturbances  and  the  nervous  dis- 
orders which  are  so  very  prevalent  may  be  pre- 
vented. Too  frequent  indulgence  at  this  period  is 
a  prolific  source  of  inflammatory  diseases,  and  often 
occasions  sterility  and  ill-health. 

The  first  nuptial  relations  should  be  fruitless,  in 
order  that  any  indisposition  arising  therefrom  should 
have  had  time  to  disappear  before  the  woman  be- 
comes pregnant. 

The  Marital  Relation. — It  is  most  important  for 
the  interest  of  both  parties  that  there  should  be 
chastity  in  the  marriage  relation  as  well  as  out  of  it. 
Many  young  couples  have  had  their  lives  ruined  by 
excessive  sexual  indulgence.  The  effect  is  usually 
most  severe  upon  the  husband,  yet  the  wife  becomes 
weak,  nervous,  and  excitable.  Sexual  excess  is  also 
the  grave  of  domestic  affection.  The  general  rule 
given  is  that  coitus  should  never  take  place  oftener 
than  every  seven  or  ten  days.  When  coitus  is  suc- 
ceeded by  langour,  depression,  or  malaise,  it  has 
been  indulged  in  too  frequently. 

Among  civilized  people  there  are  three  widely 
different  views  as  to  the  proper  course  to  be  pursued : 

First,  those  who  maintain  that  sexual  intercourse 
should  not  take  place  except  for  the  propagation 
of  the  species. 


88  Marriage. 

Second,  those  who  believe  that  the  act  is  a  love 
relation,  mutually  demanded  and  enjoyed  by  both 
sexes,  and  serving  other  purposes  besides  that  of 
procreation. 

Third,  those  who  hold  that  sexual  intercourse  is 
a  physical  necessity  for  the  man,  but  not  for  the 
woman. 

The  first  theory,  "  that  the  sexual  relations  should 
never  be  sustained  save  for  the  purpose  of  procrea- 
tion," has  many  advocates.  They  teach  that  there 
are  other  uses  for  the  procreative  element  than  the 
generation  of  offspring,  and  far  better  uses  than  its 
waste  in  pleasures.  They  claim  that  a  life  of  total 
chastity  increases  the  physical  and  mental  vigor; 
and  there  will  result  a  procreation  on  the  mental 
and  spiritual  planes,  instead  of  on  the  physical  ones. 

They  also  claim  that  to  woman  belongs  the  cre- 
ative power;  that  she  must  choose  when  a  new  life 
shall  be  evolved;  and  that  only  by  adhering  to  this 
law  can  she  be  protected  in  the  highest  function  of 
her  being  —  the  function  of  maternity. 

The  adherents  of  the  second  theory,  "  that  the  act 
is  a  love  relation,  mutually  demanded  and  enjoyed 
by  both  sexes,  and  that  it  serves  other  purposes  be- 
sides that  of  procreation,"  claim  that  the  female 
sexual  life  indicates  that  the  healthy  woman  is 
neither  indifferent  nor  passive  in  the  generative  act. 
It  has  much  the  same  effect  as  in  man  —  a  powerful 


The  Ethics  of  Married  Life.  89 

increase  in  her  sensations,  whole  groups  of  muscles 
are  set  in  motion,  and  the  uterus  as  well  as  the 
entire  nervous  system  are  in  an  excited  condition 
and  activity.  And  that  it  is  the  province  of  the 
mother  to  decide  when  a  new  life  should  begin. 

The  third  theory,  "  that  sexual  intercourse  is  a 
physical  necessity  for  the  man,  but  not  for  the 
woman,"  is  by  far  the  most  widely  accepted.  We 
will  consider,  first,  the  practical  results  of  this  last 
theory;  and,  second,  the  scientific  basis  on  which 
it  rests. 

It  is  generally  acknowledged  that  this  practice 
has  done  more  to  cause  domestic  misery,  sickness, 
and  death  than  that  dreadful  scourge  of  the  human 
race,  tuberculosis. 

This  man,  accustomed  all  his  life  to  gratify  his 
sexual  passions  promisculously,  marries  a  virtuous 
young  girl.  In  her  menstrual  periods  she  has  had 
to  do  only  with  the  secondary  phenomena;  with 
the  expulsion  of  the  ova  not  at  all.  She  has  had 
no  instruction  in  the  corresponding  physiologic  life 
of  the  man,  and  is  astonished  at  the  male  sexual 
indications,  and  is  led  to  believe  in  their  physiologic 
necessities.  The  result  is  that  she  not  only  suffers 
physically,  but  feels  outraged  and  disgraced.  She 
is  liable  to  the  chance  of  maternity  at  any  time; 
and  such  offspring  will  probably  be  sickly. 

Passion  is  presented  to  the  young  wife  in  so 


go  Marriage. 

hideous  a  guise  that  it  will  take  the  utmost  con- 
sideration of  her  husband  afterward  to  enable  her 
to  completely  overcome  her  repugnance.  If  she  be 
worn  and  weary  of  excesses  in  the  early  days  of 
her  married  life,  the  husband  will  have  only  him- 
self to  blame  if  he  is  bound  all  his  life  to  an  apa- 
thetic and  irresponsive  wife.  Husbands  place  great 
strains  upon  the  affections  of  their  wives,  and  lower 
themselves  almost  past  reinstatement  in  their  respect 
and  esteem. 

Lastly,  on  what  scientific  basis  does  this  "  physi- 
logic  necessity  "  for  sexual  gratification  on  the  part 
of  the  male  rest?  Analogy  with  the  lower  animals 
does  not  bear  it  out.  Among  animals,  except  in 
rare  instances  under  domestication,  the  female  ad- 
mits the  male  in  sexual  embrace  only  for  procrea- 
tion. Among  many  savage  tribes  this  same  rule 
has  but  few  exceptions.  The  analogies  between  the 
male  and  the  female  sexual  organs ;  between  seminal 
emissions  and  menstruation ;  between  the  sexual  life 
of  the  male  and  of  the  female,  only  go  to  accentuate 
the  fact  that  this  so-called  physiologic  necessity  on 
the  part  of  the  male  has  arisen  chiefly  through  the 
difference  of  education;  so  that  it  has  come  to  be 
that  the  woman  is  chaste  and  the  man  is  degraded ; 
that  the  woman  is  too  sentimental  and  the  man  too 
passionate.  From  a  purely  medical  standpoint,  the 
most  eminent  physicians  and  physiologists  of  the 


The  Ethics  of  Married  Life.  91 

day  all  unite  in  advocating  a  chaste  and  continent 
life,  simply  for  the  sake  of  the  man's  own  health, 
independently  of  all  other  considerations. 

Times  when  Marital  Relations  Should  be  Sus- 
pended.—  The  marital  relations  should  always  be 
suspended  during  the  menstrual  period.  During 
pregnancy  intercourse  should  never,  or  at  least  very 
rarely,  be  indulged  in.  At  this  time  the  mother 
needs  to  conserve  all  her  strength  and  energies  for 
herself  and  child;  and  any  sexual  relations  during 
this  time  increase  the  sufferings  of  the  mother  and 
impair  the  vitality  of  the  child.  It  has  been  even 
suggested  that  much  of  the  pain  during  parturition 
would  be  avoided  by  entire  continence  during  preg- 
nancy. Intercourse  during  the  early  months  of 
pregnancy  is  a  frequent  cause  of  abortion.  Women 
who  have  supposed  that  they  have  never  been  preg- 
nant have  in  reality  been  having  abortions  every 
second  or  third  month. 

A  woman  should  never  be  subjected  to  coitus 
until  three  months  after  delivery.  During  lactation 
intercourse  should  never,  or  at  least  very  rarely,  be 
indulged  in;  as  the  function  of  lactation  makes  a 
heavy  drain  on  the  strength  of  the  mother,  and  any- 
thing which  would  further  weaken  her  would  tend 
to  impoverish  the  quality  of  the  milk  and  thus  the 
child  would  suffer. 


CHAPTER  VIII. 

SEXUAL  INSTINCT  IN  WOMEN. 

Sexual   Instinct   in    Women;  Excessive   Coitus; 
Causes  of  Sexual  Excitability. 

"  Virtue,   the   strength    and  beauty  of  the  soul, 
Is    the   best    gift    of   heaven." 

— Armstrong. 

Sexual  Instinct  in  Women. — After  careful  ob- 
servation of  the  sexes  in  the  married  state,  it  is 
found  that  the  sexual  appetence  is  less  in  women 
than  it  is  in  men.  Much  of  this  difference  in  sexual 
appetence  is  doubtless  due  to  the  chastity  of  their 
lives,  coupled  with  and  resulting  from  the  difference 
of  education.  The  girl  is  taught  repression,  and 
the  boy  expression ;  that  girls  must  be  chaste ;  that 
chastity  for  boys  is  impossible. 

According  to  the  intensity  of  the  sexual  instinct 
women  have  been  divided  into  three  classes :  A 
larger  number  than  is  supposed  have  little  or  no 
sexual  feeling.  Second,  those  who  are  subject  to 
strong  passion;  this  class  is  larger  than  the  first, 
but  small  as  compared  with  the  whole  of  their  sex. 
Third,  those  in  whom  the  sexual  appetite  is  mod- 

92 


Sexual  Instinct  in  Women  93 

erate;  this  class  comprises  the  vast  majority  of 
women. 

And,  even  granting  to  woman  more  pleasure  in 
sexual  indulgence  than  usually  comes  to  her  by 
largest  allowance,  it  is  safe  to  say  that  in  nine  cases 
out  of  ten  maternity,  with  its  early  pains  and  later 
cares,  greatly  lessens  her  power  of  enjoyment;  and 
that  for  the  larger  part  of  her  married  life  she  is 
either  positively  distressed  by  the  apparently  neces- 
sary demands  of  her  husband  upon  her,  and  irre- 
sponsive to  them,  or  kept  to  a  cheerful  response  by 
a  self-abnegation  and  regard  for  his  comfort,  not  to 
say  fear  of  his  moral  aberration,  which  is  a  positive 
drain  upon  her  health  and  strength. 

Excessive  Coitus. —  Those  who  are  most  fre- 
quently found  to  suffer  from  venereal  excesses  are 
the  newly  married;  especially  if  they  have  weak 
constitutions  and  excitable  temperaments.  A  great 
deal  of  mischief  is  done  by  two  persons  of  unequal 
constitutions  being  matched  together;  the  husband 
may  exhaust  the  wife  or  vice  versa,  the  weaker 
party  being  constantly  tempted  to  exceed  their 
strength.  In  all  sexual  matters  there  must  be  a 
consideration  for  others.  It  is  not  so  much  from 
selfishness  as  from  ignorance  that  such  a  mistake 
is  made.  The  ignorance  comes  from  a  lamentable 
morbid  delicacy  which  prevails  on  all  sexual  mat- 
ters, and  which  prevents  all  open  and  rational  con- 


94  Marriage. 

versation  on  them,  even  between  those  who  have 
the  most  intimate  knowledge  of  each  other. 

When  the  conjugal  act  is  repeated  too  often,  the 
man  will  become  gradually  conscious  of  diminished 
strength,  diminished  nerve  force,  and  diminished 
mental  powers.  Excess  weakens  a  man's  energies, 
and  enervates  and  effeminates  him.  Moreover,  it 
renders  him  liable  to  an  infinity  of  diseases  and  a 
readier  victim  to  death. 

Not  only  is  the  strength  of  the  constitution  low- 
ered by  the  excessive  expenditure  of  force  and  mat- 
ter requisite  for  the  perpetuation  of  the  species,  but 
this  lowered  standard  of  vitality  is  transmitted  to 
children.  There  can  be  but  little  doubt  that  this  is 
one  of  the  reasons  why  so  many  healthy  parents 
beget  sickly  children,  who  die  early.  They  have 
exhausted  themselves  of  the  material  from  which  a 
new  life  is  created,  and  so  it  is  not  properly  started 
at  the  beginning  and  never  reaches  its  highest  devel- 
opment. To  the  truth  of  this  statement  attests  the 
mental  imbecility,  the  pallid  and  attenuated  forms, 
of  the  children  who  are  the  earlier  products  of  mar- 
riage. The  effect  of  excessive  coitus  in  women  is 
seen  by  the  confirmed  ill  health  of  so  many  women 
after  marriage  and  repeated  child-bearing.  A  large 
number  of  these  cases  are  dependent  upon  alteration 
and  diseases  of  the  genitalia;  but  a  considerable 
number  are  unconnected  with  local  disease,  and  in 


Sexual  Instinct  in  Women  95 

many  other  cases  the  health  is  never  regained  after 
all  local  phenomena  have  disappeared. 

Sexual  excitement  in  the  woman  causes  certain 
congestion  of  the  genital  organs ;  and  at  the  time  of 
the  orgasm  there  is  a  reflex  movement  which  cor- 
responds to  erection,  and  which  consists  of  a  peri- 
staltic movement  of  the  tubes  and  uterus;  to  the 
uterus  also  is  ascribed  an  act  of  suction  by  which 
the  spermatozoa  are  drawn  up  into  its  interior. 
Even  when  pregnancy  does  not  follow,  the  too  fre- 
quent excitation  and  activity  of  the  uterus  in  weak 
constitutions  causes  illness,  first  of  the  genital  or- 
gans and  then  of  the  nervous  system. 

Local  diseases  caused  in  women  by  excessive  coi- 
tus are :  vaginal  catarrh,  acute  catarrh  of  the  vulva, 
acute  inflammation  of  the  lining  membrane  of  the 
uterus  as  well  as  of  the  uterus  itself,  inflammation 
of  the  ovaries,  and  even  peritonitis.  It  is  also  known 
to  be  an  important  factor  in  the  origin  of  blood- 
tumors  and  of  cancer  of  the  uterus.  Especially  is 
coitus  at  a  time  of  great  physical  fatigue  liable  to 
be  provocative  of  uterine  inflammations.  Aside 
from  ethical  considerations,  coitus  during  the  men- 
strual period  may  be  the  cause  of  rupture  of  the 
impaired  blood-vessels,  thus  causing  blood-tumors. 
Excessive  coitus  is  a  well-known  cause  of  chronic 
inflammation  of  the  uterus;  that  is,  a  habitual  con- 
gestion of  the  uterus  is  induced  by  excessive  sexual 


96  Marriage. 

intercourse.  This  has  been  frequently  mentioned 
by  authors  as  leading  to  enlargement  of  the  uterus 
in  the  non-pregnant  condition ;  and  it  is  a  still  more 
potent  factor  in  the  recently  impregnated  organ, 
whose  tissues  are  succulent  and  the  vessels  enlarged, 
a  condition  inviting  congestion  and  enhancing  the 
susceptibility  to  engorgement. 

The  general  manifestations  of  impaired  health 
in  women  due  to  excessive  coitus  are :  chronic  ane- 
mia, with  malnutrition;  impaired  and  altered  func- 
tions in  all  the  organs,  especially  those  of  the  nerv- 
ous system.  Menorrhagia  is  apt  to  be  induced  by 
overstimulation  of  the  ovaries,  together  with  ex- 
haustion and  sexual  apathy. 

The  source  of  so  much  misery  is  the  increasing 
physical  weakness  of  the  female  and  the  increasing 
nervous  weakness  of  the  male,  with  an  increasing 
sexual  excitability,  two  factors  of  tragic  effect  for 
the  wife.  Here  is  seen  the  unfortunate  result  of 
teaching  two  kinds  of  morals,  one  for  men  and 
another  for  women. 

Causes  of  Sexual  Excitability. —  Too  frequent 
genital  irritation,  onanism,  too  frequent  intercourse, 
alcohol,  too  rich  and  too  highly  seasoned  foods,  lack 
of  exercise. 

Treatment  of  Sexual  Excitability. — Avoid  alcohol 
and  precocious  puberty.  Strictest  attention  must 
be  paid  to  the  diet;    everything  is  to  be  avoided 


Sexual  Instinct  in  Women  97 

which  is  difficult  of  digestion  or  which  retards  it. 
The  following  articles  of  diet  must  all  be  avoided: 
cheese,  foods  seasoned  with  pepper  and  curry,  highly- 
salted  and  acid  foods,  and  all  rich  foods ;  and  meat 
must  be  eaten  only  in  moderate  quantities.  Con- 
stipation irritates  the  genitalia  directly  and  increases 
the  inflammation.  The  close  relation  of  Venus  and 
Bacchus  is  known  not  only  in  mythology.  Car- 
bonated waters  are  to  be  especially  avoided,  such 
as  soda,  seltzers,  Preblauer,  Geisshubler,  and  acid 
waters;  also  champagne  and  beer,  heavy  Italian, 
Spanish,  and  English  wines.  All  alcoholic  drinks 
must  be  forbidden. 

As  heavy  gymnastics  as  the  strength  of  the  indi- 
vidual will  admit,  and  plenty  of  exercise  out-of- 
doors  must  be  taken.  There  must  also  be  constant 
mental  and  physical  employment.  In  women  sexual 
excitability  is  often  caused  by  local  diseases,  and 
passes  off  with  their  cure ;  if  not,  she  must  use  her 
will-power,  and  take  the  various  forms  of  cold  baths. 
Sexual  intercourse  not  oftener  than  once  in  two 
or  three  weeks,  and  avoid  all  intimate  approaches; 
if  this  is  not  sufficient,  she  will  have  to  leave  her 
husband  for  a  few  months. 


CHAPTER  IX. 

STERILITY. 

Sterility;  the  Prevention  of  Conception  and  the 
Limitation  of  Offspring;  the  Crime  of  Abortion; 
Infidelity  in  Women. 

"  Never  let  yourselves  do  evil  that  good  may  come.  If  you  do,  you 
hinder  the  coming  of  the  real,  the  perfect  good  in  its  due  time." 

— Philmps  Brooks. 

Sterility. — Conception  is  least  apt  to  take  place 
from  the  tenth  day  after  one  period  until  the  third 
day  before  the  next ;  but  there  is  practically  no  time 
during  a  woman's  sexual  life  when  she  may  not  be 
impregnated;  in  this  connection  it  must  be  remem- 
bered that  the  spermatozoa  stay  alive  in  her  for 
more  than  a  week. 

During  lactation  women  are  generally  sterile,  es- 
pecially in  the  first  months  which  follow  the  ac- 
couchement, because  the  vital  forces  are  then  concen- 
trated on  the  secretion  of  milk. 

The  age  of  the  wife  at  the  time  of  marriage  has 
much  to  do  with  the  expectation  of  children.     As 

98 


Sterility.  99 

the  age  increases  over  twenty-five  years  the  interval 
between  the  marriage  and  the  birth  of  the  first  child 
is  lengthened.  For  it  has  been  ascertained  that  not 
only  are  women  most  fecund  between  twenty  and 
twenty-five  years,  but  that  they  begin  their  career 
of  child-bearing  sooner  after  marriage  than  either 
their  younger  or  older  sisters. 

A  wife  who  has  had  children  and  ceases  to  con- 
ceive for  three  years  will  probably  bear  no  more. 

When  marriages  are  fruitless,  the  wife  is  almost 
always  blamed;  but  it  is  by  no  means  the  wife  that 
is  always  at  fault;  many  husbands  are  absolutely 
sterile.  Every  man  is  not  prolific  who  enjoys  good 
health  and  is  vigorous.  Gross  states  that  in  one 
case  out  of  six  the  sterility  was  due  to  the  male. 
Kehrer,  after  a  series  of  carefully  conducted  experi- 
ments, has  arrived  at  the  conclusion  that  in  at  least 
a  third  of  the  cases  of  sterile  marriages  the  husband 
was  the  party  at  fault,  and  that  gonorrhea  was  the 
cause  of  the  barrenness. 

Venereal  diseases  have  their  share  of  influence, 
and  the  gonorrheal  infection  is  a  potent  cause  of 
sterility.  It  is  by  no  means  proved  that  syphilis  has 
any  unfavorable  influence  on  conception,  though 
abortions  due  to  this  are  frequent. 

Gonorrhea  often  prevents  conception  by  the  in- 
flammation traveling  up  the  womb,  and  along  the 
Fallopian  tubes  to  the  ovaries,  whose  covering  is 


ioo  Marriage. 

rendered  thick  and  dense,  so  that  the  ovum  cannot 
escape,  or  if  it  does,  the  fimbriated  end  of  the  tube 
is  so  agglutinated  that  it  cannot  grasp  the  ovum. 

Alcoholism  is  considered  a  cause  of  sterility.  It 
evidently  does  diminish  the  sexual  potency  in  the 
male,  and  for  this  the  female  is  often  blamed. 

It  does  not  follow  because  a  woman  has  not  given 
birth  to  a  child  that  she  has  not  conceived.  The 
life  of  an  infant  for  a  long  time  after  birth  is  a 
frail  one,  and  before  birth  its  existence  is  extremely 
precarious;  it  often  perishes  a  few  days  after  con- 
ception. A  period  coming  on  a  few  days  late,  and 
at  the  same  time  one  which  is  unusually  profuse, 
is  the  only  evidence  which  the  young  wife  may 
have  of  an  abortion.  Among  prostitutes,  the  fre- 
quent delay  of  menstruation,  then  abundant  hem- 
orrhage, is  in  many  cases  only  habitual  abortion, 
and  leads  to  changes  in  the  generative  organs  which 
must  result  in  sterility.  A  tendency  to  miscarriage 
may  therefore  be  all  that  stands  in  the  way  of  hav- 
ing a  family;    this  can  frequently  be  remedied. 

Sexual  incompatibility  is  well  known  to  exist; 
prominent  examples  being  Augustus  and  Livia; 
Napoleon  and  Josephine.  It  is  also  a  well-known 
fact  that  frigidity  is  a  cause  of  barrenness.  A  short 
separation  of  husband  and  wife  is  often  salutary  in 
its  influence  upon  fertility. 

It  is  a  well-established  fact  that  the  time  imme- 


Sterility.  101 

diately  before  the  period,  but  still  more  that  imme- 
diately following  the  period,  are  the  most  favorable 
times  for  conception  to  take  place;  the  remaining 
quiet  in  bed  of  the  woman  after  the  generative  act 
is  also  favorable  to  conception. 

The  most  frequent  causes  of  sterility  in  women 
are  inflammation  of  the  lining  membrane  of  the 
uterus,  or  of  the  neck  of  the  uterus,  or  of  both. 
The  source  of  this  condition  in  women  who  have 
had  children  is  most  frequently  due  to  parturition 
or  abortion.  In  the  newly  married  it  may  be  due 
to  a  previously  existing  slight  uterine  catarrh  in  a 
displaced  uterus,  or  it  may  be  a  manifestation  of  a 
run-down  state  of  the  system.  In  a  majority  of  the 
newly  married,  however,  the  inflammation  of  the 
endometrium  is  probably  due  to  the  first  efforts  at 
conjugal  approach.  Many  young  women  as  the 
result  of  the  preparation  of  the  trosseau,  augmented 
by  a  round  of  gaities  at  the  time  of  marriage,  enter 
the  married  state  in  a  condition  bordering  on  phy- 
sical and  nervous  exhaustion;  and  then  begin  en- 
gorgements and  inflammations  which  lead  to  future 
suffering  and  to  sterility.  Displacements  and  flex- 
ions of  the  uterus  also  cause  sterility.  Such  dis- 
placements of  the  neck  of  the  uterus  may  occur 
that,  instead  of  lying  in  a  pool  of  semen,  as  it  should, 
it  is  above,  in  front  of,  or  away  from  it,  and  this 
may  prevent  conception. 

PHYSICIANS  c.  SURG1E0KS 


102  Marriage. 

Vulvar  and  vaginal  hyperesthesia,  inflammations 
of  the  vulva,  undue  shortness  of  the  vagina,  unless 
great  care  is  exercised  by  the  husband,  will  induce 
painful  coitus,  and  may  bring  about  sterility  by 
favoring  the  formation  of  a  copulation  sac  outside 
of  the  axis  of  the  uterine  canal,  and  consequently 
misdirection  of  the  semen. 

Scrofula,  probably  by  its  effects  on  the  general 
condition,  leading  to  deficient  development  of  the 
whole  body,  the  genital  organs  included,  may  be 
productive  of  sterility. 

The  female  being  less  passionate  than  the  male, 
the  orgasm  comes  on  later  with  her,  or  the  male 
orgasm  occurs  so  soon  that  she  may  not  reach  that 
stage  at  all.  If  both  were  simultaneous,  it  is  rea- 
sonable to  suppose  that  conception  would  be  more 
likely  to  occur. 

Ovulation  is  doubtless  more  frequently  performed 
in  some  women  than  in  others.  Some  women  con- 
ceive with  more  or  less  regularity  every  fifteen  or 
eighteen  months,  and  others  at  intervals  of  several 
years. 

The  effect  of  repeated  coition,  provided  that  im- 
pregnation does  not  take  place  at  once,  is  to  engorge 
the  uterine  vessels,  to  alter  the  nature  of  the  glandu- 
lar secretions,  to  cause  profound  reflex  disturbances, 
and  thus  to  produce  such  changes  in  the  endome- 
trium as  to  lead  to  local  inflammation  and  to  general 

3  ftBJJt 


Sterility.  103 

nervous  exhaustion.  Bachache,  leucorrhea,  and  irri- 
table bladder  are  the  first  symptoms  of  this  disorder ; 
but  frequently  there  are  added  to  these,  headache, 
indigestion,  rectal  tenesmus,  painful  and  profuse 
menstruation.  In  many  cases  the  disease  continues 
in  a  mild  catarrhal  form,  giving  the  woman  little 
inconvenience  besides  the  slight  leucorrheal  dis- 
charge which  stains  her  clothing;  but  often  this  is 
indicative  of  such  a  change  of  the  lining  membrane 
of  the  uterus  as  to  render  it  unfit  for  the  fixation 
and  development  of  the  ovum,  even  should  impreg- 
nation take  place. 

Under  normal  conditions,  during  the  intermen- 
strual period,  a  plug  of  clear  viscid  mucus,  which  is 
secreted  by  the  glands  of  the  cervical  canal,  blocks 
up  that  passage,  but  is  washed  away  each  month  by 
the  menstrual  discharge.  Under  ordinary  conditions 
this  obstruction  must  seriously  interfere  with  the 
entrance  of  the  spermatozoa  into  the  cavity  of  the 
uterus,  and  renders  the  former  theory,  recently 
revived  by  Bossi,  quite  tenable,  that  impregnation 
is  most  likely  to  occur  just  after  the  menstrual 
epoch. 

The  vaginal  secretion  under  certain  pathologic 
conditions  may  become  so  acid  that  it  induces  ster- 
ility. Women  who  suffer  from  severe  vaginal  ca- 
tarrh are  frequently  sterile,  the  spermatozoa  being 
found  dead  in  the  vagina  some  hours  after  copula- 


104  Marriage. 

tion,  although  an  examination  a  shorter  time  after- 
ward revealed  them  still  alive.  In  cases  where  con- 
ception takes  place  in  spite  of  a  very  acid  condition 
of  the  vaginal  secretion,  it  is  probable  that  some 
of  the  spermatozoa  enter  the  uterus  before  the  secre- 
tion has  had  time  to  act  on  them,  or  possibly  the 
spermatozoa  being  injected  in  a  mass,  the  acid  secre- 
tion is  unable  to  penetrate  and  kill  them  all. 

The  reaction  of  the  normal  vaginal  mucus  is 
always  acid,  that  of  the  cervix  alkaline;  but  as  the 
result  of  the  inflammatory  condition,  the  reaction 
of  each  is  often  intensified,  especially  that  of  the 
vagina,  which  has  an  exceedingly  sour  and  pene- 
trating odor.  This  acid  discharge,  bathing  the  neck 
of  the  uterus,  penetrates  more  or  less  into  the  cer- 
vical plug  and  causes  coagulation  of  the  alkaline 
mucus. 

The  chief  constituent  of  the  semen  is  albumin; 
agents  which  affect  albuminous  substances  influence 
the  functional  activity  of  the  spermatozoa  —  heat, 
concentrated  acids,  and  probably  concentrated  alka- 
lies. In  normal  conditions  the  alkalinity  of  the 
seminal  fluid  seems  to  be  sufficient  to  neutralize  the 
acidity  of  the  vaginal  secretions,  so  that  the  sperma- 
tozoa may  remain  seventeen  days  or  more  (Bossi) 
within  the  vaginal  canal,  even  during  a  menstrual 
period,  without  having  their  vitality  destroyed. 

When  hyperacidity  of  the  vaginal  secretion  is 


Sterility.  105 

present,  it  is  probable  that  the  fertilizing  element 
is  at  once  rendered  inert;  but  should  some  of  the 
spermatozoa  succeed  in  reaching  the  interior  of  the 
cervical  canal,  the  increased  alkalinity  of  the  secre- 
tion there  would  in  all  probability  put  an  end  to 
all  further  progress. 

The  conditions,  then,  which  appear  to  prevent 
fecundation  are:  First,  the  absence  of  the  proper 
nidus  for  the  ovum;  second,  the  obstruction  of  the 
cervical  canal  by  a  mucus  plug;  third,  increased 
alkalinity  of  the  cervical  secretion,  often  accom- 
panied by  the  increased  acidity  of  the  vaginal  secre- 
tion. Three  conditions  must,  then,  be  determined : 
First,  are  there  spermatozoa  in  the  semen  ?  Second, 
do  they  get  into  the  uterocervical  canal?  Third, 
do  the  secretions  in  the  canal  poison  the  sperma- 
tozoa ? 

"  For  those  who  are  very  anxious  for  offspring," 
wrote  Marion  Sims,  "  I  usually  order  sexual  inter- 
course on  the  third,  fifth,  and  seventh  days  after  the 
flow  has  ceased;  and  on  the  fifth  and  third  days 
before  its  return.  For  the  most  obvious  reasons 
this  would  always  be  before  going  to  bed  at  night, 
instead  of  just  before  rising  in  the  morning.  The 
horizontal  position  favors  the  retention  of  semen; 
the  erect  its  expulsion.  I  am  satisfied  that  too  fre- 
quent sexual  indulgence  is  fraught  with  mischief 
to  both  parties.     It  weakens  the  semen;    in  other 


106  Marriage. 

words,  that  this  is  not  so  rich  in  spermatozoa  after 
too  frequent  indulgence;  and  when  carried  to  the 
extent  of  a  debauch,  the  fluid  ejaculated  may  be 
wholly  destitute  of  spermatozoa.  Thus  it  will  be 
seen  that  it  will  be  much  better  to  husband  the  re- 
sources of  both  man  and  wife." 

The  Prevention  of  Conception  and  the  Limita- 
tion of  Offspring. — Some  of  the  contraindications  to 
procreation  are  when  either  parent  suffers  from  a 
disease  which  is  transmissible,  and  such  diseases 
frequently  manifest  themselves  only  after  marriage ; 
when  the  pregnancy  would  endanger  the  mother's 
life,  or  even  where  the  pregnancy  is  a  nine  months' 
torture  to  her ;  where  either  parent  is  suffering  from 
ill  health ;  or  where  for  economical  reasons  no  more 
children  are  desired. 

If  there  exists  no  condition  in  either  parent  or  in 
their  circumstances  why  they  should  not  have  chil- 
dren, the  next  consideration  due  to  their  children, 
is  how  the  same  may  be  procreated  under  the  most 
favorable  conditions  possible ;  this  condition  can  only 
be  secured  by  making  the  circumtsances  such  that 
the  mother  shall  be  able  to  choose  the  time  for  their 
conception  when  both  parents  are  in  the  best  phy- 
sical condition.  That  children  should  be  brought 
into  the  world  haphazard,  as  the  result  of  accident, 
is  to  degrade  the  human  race  below  that  of  the  lower 
animals,  where  the  female  admits  the  male  only  at 


Sterility.  107 

the  time  of  the  rut,  which  in  the  majority  of  cases 
occurs  only  once  a  year. 

Another  requisite  to  bearing  healthy  children  is 
that  the  pregnancies  shall  not  follow  each  other  too 
rapidly.  Aside  from  the  consideration  for  the  health 
of  the  mother  herself,  she  must  be  in  good  physical 
condition  to  bear  the  healthiest  children  she  is  capa- 
ble of  giving  birth  to;  and  for  this  there  must  be 
frorfi  two  and  a  half  to  three  years  between  the 
successive  pregnancies.  The  results  of  overproduc- 
tion on  the  children  are  frequently,  that  they  are 
sickly,  short-lived,  or  suffer  from  rickets,  cerebral 
paralysis,  idiocy,  or  imbecility. 

And  last,  but  certainly  not  least,  many  women 
become  chronic  invalids,  or  are  hastened  to  pre- 
mature graves,  by  having  children  as  fast  as  they 
possibly  can. 

The  most  natural  and  moral  way  for  the  artificial 
prevention  of  conception,  when  on  account  of  ill 
health  or  for  economic  reasons  no  more  children 
are  desired,  is  to  abstain  from  sexual  intercourse. 
But  in  the  majority  of  cases  the  husband  will  not 
agree  to  this,  and  so  the  greatest  number  of  methods 
have  come  to  be  used  to  prevent  conception. 

Perhaps  the  most  frequent  method  use  to  prevent 
conception  is  withdrawal  before  the  ejaculation  of 
semen.  While  this  is  most  injurious  to  the  husband 
—  debility,  nervous  prostration,  and  even  paralysis 


108  Marriage. 

are  said  to  ensue  —  the  health  of  the  wife  also  suf- 
fers. If  this  interrupted  sexual  congress  is  con- 
tinued for  years,  there  develop  gradual  nervous  dis- 
turbances on  both  sides,  and  a  serious  disease  of  the 
uterus  makes  itself  felt.  The  generative  organs 
become  engorged  with  blood,  but  are  not  permitted 
to  enjoy  relaxation  consequent  upon  the  full  comple- 
tion of  the  act.  This  engorgement  may  lead  to 
undue  local  nutrition,  and  diffuse  growth  and  pro- 
liferation of  the  connective  tissue  may  take  place. 
Hence  the  uterine  walls  become  dense  and  thickened 
and  the  nerves  compressed.  Of  course,  pain  and 
tenderness  and  a  sense  of  bearing  down  will  be  the 
result.  Flexions  and  versions  may  be  consequent 
upon  the  engorgement.  The  nerves  become  shat- 
tered, and  the  woman  will  be  fortunate  if  she  con- 
tracts no  serious  womb  trouble. 

"  It  is  strange,"  says  John  Stuart  Mill,  "  that  in- 
temperance in  drink  or  any  other  appetite,  should 
be  condemned  so  readily,  but  that  incontinence  in 
this  respect  should  always  meet  not  only  with  indul- 
gence, but  with  praise.  Little  improvement  can  be 
expected  in  morality  until  the  producing  of  too  large 
families  is  regarded  with  the  same  feeling  as  drunk- 
enness, or  any  other  physical  excess." 

Sismondi  writes :  "  When  our  true  duties  toward 
those  whom  we  give  life  are  not  obscured  in  the 
name  of  a  sacred  authority,  no  man  will  have  more 


Sterility.  109 

children  than  he  can  properly  bring  up.  If  a  woman 
has  a  right  to  decide  any  question  it  is  how  many 
children  she  should  bear.  Whenever  it  becomes 
unwise  that  the  family  should  be  increased,  justice 
and  humanity  require  that  the  husband  should  im- 
pose on  himself  the  same  restraint  which  is  sub- 
mitted to  by  the  unmarried." 

In  the  opinion  of  Dr.  Edward  Reich,  it  is  very 
much  to  be  wished  that  the  function  of  conception 
should  be  placed  under  the  domain  of  the  will. 

But  the  strongest  appeal  has  been  made  for  the 
sake  of  morality  itself;  namely,  to  prevent  the 
crime  of  abortion.  Dr.  Raciborski,  of  Paris,  took 
the  position  that  the  prevention  of  offspring  to  a 
certain  extent  is  not  only  legitimate,  but  it  is  to  be 
recommended  as  a  means  of  public  good. 

Continence,  self-control,  and  a  willingness  to  deny 
himself  —  that  is  what  is  required  of  the  husband. 
But  suffering  women  assure  us  that  this  will  not 
suffice;  that  men  refuse  to  restrain  themselves; 
that  it  leads  to  loss  of  domestic  happiness,  to  ille- 
gitimate amours;  or  that  it  is  injurious  physically 
and  mentally;  that,  in  short,  such  advice  is  useless 
because  it  is  impracticable. 

Dr.  Napheys  writes :  "  Is  it  amiss  to  hope  that 
science  will  find  resources,  simple  and  certain,  which 
will  enable  a  woman  to  let  reason  and  sound  judg- 


no  Marriage. 

merit,  not  blind  passions,  control  the  increase  of  her 
family?" 

The  Crime  of  Abortion. — From  the  moment  of 
conception  a  new  life  begins,  a  new  individual  exists ; 
another  child  is  added  to  the  family.  The  mother 
who  deliberately  sets  about  to  destroy  this  life  by 
want  of  care,  or  by  taking  drugs,  or  by  the  use  of 
instruments,  commits  a  great  crime,  and  is  just  as 
guilty  as  if  she  strangled  her  new-born  infant.  The 
crime  she  commits  is  child-murder.  Women  in  their 
frenzy  at  rinding  themselves  in  this  condition,  and 
with  no  slightest  idea  of  the  sin  that  they  are  com- 
mitting, are  constantly  guilty  of  committing  abor- 
tions on  themselves,  or  going  to  professional  abor- 
tionists to  have  this  crime  of  child-murder  com- 
mitted. This  is  another  of  the  sins  due  to  the  ignor- 
ance of  the  sex  in  all  matters  pertaining  to  repro- 
duction ;   and  it  is  a  fearfully  prevalent  one. 

Infidelity  in  Women. — "We  have  now  reached 
the  last  infernal  circle  of  the  divine  comedy  of  mar- 
riage; we  are  at  the  depths  of  the  inferno.  There 
is  something,  I  do  not  know  what,  terrible  in  the 
situation  in  which  a  married  woman  finds  herself 
when  an  illegitimate  love  has  ruined  her  for  the 
duties  of  a  wife  and  mother.  As  has  been  so  well 
and  strongly  expressed  by  Diderot,  infidelity  in 
woman  is  like  incredulity  in  a  priest;   it  is  the  last 


Sterility.  1 1 1 

step  in  human  forfeitures;    it  is  for  her  the  great 
social  crime,  for  it  implies  all  the  others. 

"  Weigh  the  sufferings  of  the  future,  the  agonies 
of  years  by  the  ecstasy  of  half  an  hour.  If  this 
conservative  sentiment  of  the  creature,  the  fear  of 
death,  does  not  stop  her,  what  could  be  expected 
of  laws?    Oh,  sublime  infamy!  " — (Balzac). 


PART  I II. -MATERNITY. 


CHAPTER  X. 

PREGNANCY. 

Nature  of  Conception;  Pregnancy  Defined;  Dura- 
tion of  Pregnancy ;  the  Signs  of  Pregnancy; 
Quickening;  the  Determination  of  Sex  at  Will; 
the  Influence  of  the  Male  Sexual  Element  on  the 
Female  Organism;  Heredity;  Hygiene  of  Preg- 
nancy; Causes  of  Miscarriage. 

"  Happy  he 
With  such  a  mother,   faith  in  womankind 
Beats  with  his  bood,  and  trust  in  all  things  high 
Comes  easy  to  him,  and  though   he  trip  and   fall, 
He   shall  not  bind  his  soul  with  clay." 

— Tennyson. 

Nature  of  Conception. — Conception,  or  impregna- 
tion, is  the  union  of  the  germ  and  the  sperm  cell, 
the  result  of  which  is  a  new  being.  On  coition,  the 
semen  being  received  into  the  female  organs,  which 
are  at  that  time  in  a  state  of  turgescence,  the  sperma- 
tozoa, by  means  of  their  own  vibratile  activity,  find 
their  way  into  the  Fallopian  tubes,  and  here  come 
in  contact  with  the  ovule. 

112 


Pregnancy.  113 

The  ovule  is  a  minute  cell  with  a  transparent 
membrane,  within  which  is  the  yolk  containing  the 
germinal  vesicle.  The  spermatozoon  penerates  into 
the  ovule  and  becomes  fused  with  it.  The  processes 
of  development  begin  at  once  to  occur.  There  is 
congestion  of  the  uterine  mucous  membrane  out  of 
proportion  to  the  rest  of  the  uterus ;  the  ovum  finds 
lodging  here,  and  becomes  surrounded  by  a  mem- 
brane which  incloses  it  in  a  separate  sac. 

Pregnancy  Defined. — Pregnancy  begins  with  con- 
ception and  ends  with  parturition;  it  provides  for 
the  nutrition  and  the  expulsion  of  the  embryo  and 
for  its  nutrition  for  a  short  time  after  birth. 

The  average  duration  of  pregnancy  is  ten  lunar 
months,  or  two  hundred  and  eighty  days.  The 
date  of  the  confinement  is  calculated  by  reckoning 
from  the  date  of  the  last  menstrual  flow;  count 
backward  three  months  from  the  date  of  the  first 
appearance  of  the  last  menses;  to  this  add  twelve 
months  and  seven  days,  five  days  being  for  the 
average  menstrual  duration  and  two  days  for  the 
possibility  of  fecundation. 

Duration  of  Pregnancy. — Many  difficulties  are  ex- 
perienced in  determining  the  date  of  the  expected 
confinement.  As  most  pregnancies  occur  in  married 
women,  we  cannot  base  any  calculations  on  a  single 
act  of  coitus.  And  even  if  there  was  but  one,  all 
physiologists  agree  that  there  is  a  variable  period 


H4  Maternity. 

in  different  women,  and  in  the  same  woman  at  dif- 
ferent times,  between  insemination  and  the  fertiliza- 
tion of  the  ovum.  It  is  the  moment  of  fecundation, 
or  the  union  of  the  germ  and  sperm  cells,  which 
marks  the  beginning  of  pregnancy.  The  uncer- 
tainty becomes  still  greater  owing  to  our  inadequate 
knowledge  as  to  the  length  of  time  during  which 
the  sexual  elements,  the  ova  and  the  spermatozoa, 
retain  their  vitality  after  liberation  from  their  re- 
spective sources.  While  it  is  not  certainly  known, 
it  is  probable  that  the  ovum  is  capable  of  impreg- 
nation any  time  during  its  sojourn  within  the  ovi- 
duct and  before  reaching  the  uterus,  or  probably  for 
a  period  of  about  one  week  from  the  time  of  its 
escape  from  the  Graafian  follicle.  The  remarkable 
vitality  of  the  spermatozoa  even  under  less  favor- 
able circumstances  —  direct  observation  shows  that 
these  elements  retain  their  movements  for  over  nine 
days  outside  of  the  body  —  renders  it  almost  cer- 
tain that  their  powers  of  fertilization  are  maintained 
for  a  long  time  after  they  are  deposited  within  the 
healthy  female  genital  tract;  it  is  believed  that  the 
spermatozoa  are  capable  of  fertilization  after  a  so- 
journ of  three  or  more  weeks  within  the  oviduct. 

Consideration  of  these  facts  renders  apparent  the 
impossibility  of  fixing  with  certainty  the  date  of 
the  beginning  of  pregnancy,  since  conception  may 
result  from  the  union  of  the  ovum  liberated  at  the 


Pregnancy.  115 

beginning  of  the  period  with  the  spermatozoon  in- 
troduced at  the  end  of  that  time;  or  it  may  result 
from  the  meeting  of  the  male  elements  already 
within  the  oviduct  with  an  ovum  discharged  a  day 
or  two  before  the  occurrence  of  the  menstrual  period. 

The  Signs  of  Pregnancy. — The  cessation  of  the 
menstrual  period  is  the  sign  of  the  greatest  value 
in  women  who  have  been  regular;  but  it  must 
always  be  remembered  that  there  may  be  an  irregu- 
larity of  menstruation  for  the  first  few  months  after 
marriage.  The  appetite  is  capricious;  morning 
sickness  or  nausea  in  the  morning  on  first  getting 
up  is  a  very  common  symptom  in  the  early  months 
of  pregnancy;  enlargement  of  the  abdomen;  in 
the  first  two  months  of  pregnancy  the  abdomen  is 
flattened  and  the  umbilicus  is  depressed;  after  this 
the  abdomen  begins  to  enlarge.  There  is  also  an 
increase  in  the  size  of  the  breasts,  with  a  deepened 
color  of  their  areolae  and  later  a  watery  secretion. 
The  external  genitals  become  swollen  and  of  a 
bluish  color.  Feeling  of  the  fetal  movements  — 
that  is,  the  movements  of  the  small  parts  of  the 
child  in  the  womb  —  by  the  mother  is  not  always 
reliable,  since  gas  in  the  intestines  has  sometimes 
been  mistaken  for  this.  These  signs  are  more  val- 
uable when  several  exist  together. 

The  nausea  and  vomiting  of  pregnancy,  the  so- 
called  morning  sickness,  consists  of  nausea  accom- 


n6  Maternity. 

panied  often  by  vomiting  or  retching  of  a  glairy 
fluid,  showing  itself  most  frequently  on  rising  in 
the  morning,  but  sometimes  appearing  after  break- 
fast. It  is  aggravated  by  the  assumption  of  the 
erect  position.  It  may  begin  within  a  few  days, 
but  as  a  rule  it  does  not  show  itself  until  the  fourth 
week  of  pregnancy;  and  it  generally  ceases  about 
the  fourth  month,  rarely  persisting  throughout  the 
entire  time.  In  the  majority  of  cases  it  does  not 
sensibly  impair  the  health.  It  is  a  sympathetic  dis- 
order reflected  from  the  uterus;  it  is  aggravated 
by  indigestible  food,  by  sexual  excitement,  and  by 
emotional  disturbances;  it  is  most  marked  in  first 
pregnancies  and  in  women  of  highly  emotional  na- 
tures. It  is  not  infrequently  due  to  some  inflam- 
mation of  the  uterus  or  erosion  about  the  external 
orifice,  and  disappears  on  the  removal  of  the  cause. 

Mammary  Changes.  —  During  pregnancy  the 
mammary  glands  are  in  immediate  sympathy  with 
the  growing  reproductive  organs  of  the  pelvis ;  con- 
sequently a  genuine  physiologic  enlargement  com- 
mences in  these  organs  from  the  beginning  of  ges- 
tation. Their  glandular  structure  becomes  larger, 
fuller,  and  firmer ;  a  sensation  of  weight  or  pricking 
is  felt  by  the  patient ;  the  veins  become  more  prom- 
inent. The  nipples  also  become  enlarged,  more 
elongated,  and  somewhat  erect.  Surrounding  the 
nipple  is  the  areola;   this  becomes  darker  in  color. 


Pregnancy.  117 

In  most  women  a  drop  of  watery  fluid,  the  so-called 
colostrum,  may  be  squeezed  out  from  the  nipple  at 
the  end  of  the  third  month  of  pregnancy. 

The  signs  of  pregnancy  are  divided  into  the  pre- 
sumptive, the  probable,  and  the  positive  The  pre- 
sumptive signs  are :  menstrual  suppression,  morning 
sickness,  irritable  bladder,  mental  and  emotional 
phenomena.  The  probable  sigs  are:  mammary 
changes,  abdominal  enlargement,  changes  in  the 
neck  of  the  womb,  and  certain  changes  which  are 
felt  on  bimanual  examination.  The  positive  signs 
are:  feeling  the  various  parts  of  the  fetus,  active 
movements  of  the  fetus,  and  hearing  the  fetal  heart 
sounds. 

Functional  disturbances  of  the  bladder  are  quite 
often  noticeable  in  the  early  part  of  the  pregnancy. 
In  the  first  part  of  the  pregnancy  the  bladder  is 
dragged  upon,  and  later  is  is  pressed  upon  by  the  en- 
larged uterus  so  that  the  bladder  capacity  is  lessened 
and  frequency  of  urination  is  the  result.  In  the  fourth 
month,  when  the  uterus  ascends  into  the  abdominal 
cavity,  these  bladder  symptoms  subside,  until  the 
very  close  of  the  pregnancy,  when  by  the  descent 
of  the  now  greatly  enlarged  uterus  there  may  be 
even  incontinence  of  urine. 

Changes  in  the  Abdomen. — During  the  first  two 
months  of  the  pregnancy  there  is  a  flattening  of  the 
abdominal  surface,  due  to  the  descent  of  the  uterus 


u8  Maternity. 

into  the  pelvic  cavity,  thus  slightly  dragging  the 
bladder  downward  and  drawing  the  umbilicus  in- 
ward. In  the  latter  part  of  the  fourth  month  there 
is  noticeable  a  slight  abdominal  enlargement,  and 
the  umbilicus  is  no  longer  sunken.  By  the  end  of 
the  fourth  month  the  base  of  the  uterus  has  risen 
two  inches  above  the  symphysis,  and  at  the  end 
of  the  thirty-eighth  week  it  touches  the  lower  ex- 
tremity of  the  breast-bone;  the  umbilicus  has  been 
for  many  weeks  protruding;  during  the  last  two 
weeks  of  pregnancy  the  uterus  again  descends  and 
the  woman  feels  more  comfortable. 

On  the  inspection  of  the  abdomen  of  a  pregnant 
woman  there  will  be  noticed  a  brown  line  which 
extends  from  the  umbilicus  to  the  pubes,  and  all 
over  the  surface  the  presence  of  striae,  or  long  purple 
grooves,  due  to  the  distention  of  the  abdomen;  on 
the  sides  of  the  abdomen  and  down  the  thighs,  red, 
blue,  or  white  markings,  like  cicatrices,  may  be  seen. 

Quickening. — Quickening  is  the  sensation  expe- 
rienced by  the  mother  as  the  result  of  the  active 
fetal  movements  of  the  child  in  the  womb.  These 
movements  are  first  felt  between  the  eighteenth  and 
the  twentieth  week;  the  common  rule  is  that  quick- 
ening occurs  at  the  middle  "of  pregnancy;  that  is, 
at  four  and  a  half  months.  As  pregnancy  advances 
these  active  motions  increase  in  frequency  and  be- 
come more  marked.      When   felt  or  seen  by  the 


Pregnancy.  1 19 

physician,  as  can  be  done  in  the  sixth  month,  fetal 
movements  constitute  a  positive  sign  of  pregnancy. 

The  Determination  of  Sex  at  Will. —  Although 
this  has  always  been  a  question  of  great  interest, 
and  the  subject  of  much  experimentation,  no  rule 
can  as  yet  be  given  by  which  the  parents  can  know 
in  advance  of  the  birth  of  the  child  what  the  sex 
will  be.  Dr.  Schenck's  theory  is  that  the  ruling 
factor  in  determining  the  sex  is  the  food  partaken 
of  by  the  mother. 

Fiirst  believes  that  the  differentiation  may  occur 
before,  during,  and  a  little  while  after  the  impreg- 
nation ;  that  the  chances  of  the  development  of  one 
or  another  sex  in  one  and  the  same  woman  may 
vary  before  final  differentiation  occurs.  It  is  im- 
possible to  determine  the  sex  of  the  embryo  before 
the  tenth  week  of  fetal  life.  The  cause  of  the  dif- 
ferentiation, he  believes,  lies  largely  in  the  good 
or  bad  state  of  the  health  of  the  parents;  in  the 
first  instance  there  being  an  excess  of  females,  and 
in  the  latter  an  excess  of  males,  relatively  speaking. 
He  believes  that  there  is  an  excess  of  male  children 
when  conception  takes  place  during  the  post-men- 
strual anemia.  He  has  investigated  one  hundred 
and  ninety-three  cases  carefully  in  regard  to  the 
probable  date  of  conception  after  menstruation,  and 
there  is  a  notable  increase  of  male  births  over  female 
in  the  cases  where  conception  occurred  in  the  first 


120  Maternity. 

five  days  after  menstruation;  that  is  to  say,  where 
the  woman  is  not  so  well  nourished  as  later. 

Dr.  J.  Griffith  Davis  gives  as  the  result  of  her 
experiments  in  this  direction,  that  when  conception 
takes  place  three  days  before  the  menstrual  period 
or  within  forty-eight  hours  afterward,  the  child 
will  be  a  girl;  when  conception  takes  place  ten 
days  after  the  period,  the  child  will  be  a  boy. 

Although  there  are  a  greater  number  of  the 
female  than  the  male  sex  in  all  parts  of  the  world 
where  reliable  statistics  have  been  taken,  in  all  civil- 
ized countries  the  proportion  of  male  births  is 
greater  than  that  of  females.  There  is  a  greater 
tendency  of  the  male  offspring  to  die  earlier,  and 
this  is  seen  even  before  birth,  in  the  proportion  of 
three  to  two.  For  this  reason  the  stronger  sex  as 
applied  to  men  has  been  regarded  by  some  authors 
as  a  misnomer.  They  are  physically  weaker  in 
early  life  and  succumb  more  readily  to  noxious 
influences. 

The  relative  age  of  the  parents  is  said  to  be  an- 
other factor  in  determining  the  sex  of  the  children. 
Seniority  on  the  father's  side  gives  an  excess  of 
male  children;  equality  in  the  age  of  the  parents 
gives  a  slight  preponderance  of  females;  seniority 
on  the  mother's  side  gives  an  excess  of  females. 
Men,  and  especially  scholars,  who  pass  a  sedentary 
life  and  who  exhaust  their  nervous  force  to  a  great 


Pregnancy.  121 

extent,  beget  more  girls  than  boys ;  so,  also,  a  very 
advanced  age  on  the  part  of  the  man  diminishes  the 
number  of  male  offspring. 

The  Influence  of  the  Male  Sexual  Element  on  the 
Female  Organism. — Dr.  Alexander  Harvey,  of  Ab- 
erdeen, has  adopted  the  theory  of  fetal  inoculation. 
He  believes  that  the  effect  is  first  due  to  the  influence 
of  the  male  element  upon  the  ovum,  which,  in  con- 
sequence of  the  subsequent  close  attachment  and 
freely  inter-communicating  blood-vessels  between 
the  modified  embryo  and  the  mother,  inoculates  the 
condition  of  the  mother  with  the  qualities  of  the 
male;  and  so,  on  the  subsequent  impregnation  by 
another  male,  the  offspring  resembles  the  first  male 
and  not  its  real  parent.  He  even  goes  further,  and 
says  that  it  is  conceivable,  by  successive  impregna- 
tions effected  by  him,  that  the  influence  may  be 
increased,  and  if  so  the  younger  children  begotten 
by  him,  rather  than  the  elder,  might  be  expected, 
ceteris  paribus,  to  bear  their  father's  image.  And 
as  regards  the  mother,  he  suggests  the  question, 
whether  there  is  not  something  in  the  popular  notion 
that  in  the  course  of  years  the  wife  comes  to  re- 
semble the  husband ;  and  that  not  merely  in  respect 
of  temper,  disposition,  or  habits  of  thought,  but  in 
bodily  appearance,  which  may  be  referable  to  this 
influence  exerted  by  the  husband  on  her  constitu- 
tion, through  the  medium  of  the  fetuses  in  utero. 


122  Maternity. 


Yet  it  shall  be;  thou  shalt  lower  to  his  level  day  by  day, 

What  is  fine  within  thee  growing  coarse  to  sympathize  with  clay. 

As  the  husband  is  the  wife  is;  thou  art  mated  with  a  clown. 
And  the  grossness  of  his  nature  will  have  weight  to  drag  thee  down. 

He  will  hold  thee,  when  his  passion  shall  have  spent  its  novel  force, 
Something  better  than  his  dog,  a  little  dearer  than  his  horse." 


Darwin,  on  the  other  hand,  considers  it  a  most 
improbable  hypothesis  that  the  mere  blood  of  one 
individual  should  affect  the  reproductive  organs  of 
another  individual  in  such  a  manner  as  to  affect  the 
subsequent  offspring.  The  analogy,  he  says,  from 
the  direct  action  of  the  foreign  pollen  on  the  ovaries 
and  seed  coats  of  the  mother  plant  strongly  supports 
the  belief  that  the  male  element  acts  directly  on  the 
reproductive  organs  of  the  female,  and  not  through 
the  intervention  of  the  crossed  embryo. 

Dr.  John  Brown,  in  reviewing  the  subject,  says 
it  must  be  conceded  that  the  male  element  has  an 
influence  on  the  female,  over  and  above  its  fertiliz- 
ing influence  upon  the  ovum.  The  limit  of  this 
influence  is  at  present  unknown. 

Heredity. — Girls  are  more  apt  to  resemble  their 
fathers  in  mental  traits,  disposition,  and  constitu- 
tion; while  boys  take  after  their  mothers.  Boys 
procreated  by  intelligent  mothers  will  be  intelligent ; 
while  it  does  not  always  follow  that  the  sons  of 
intelligent  fathers  are  intelligent.  The  poets  Burns, 
Ben  Johnson,   Gcethe,   Walter   Scott,   Byron,   and 


Pregnancy.  123 

Lamartine  were  all  born  of  women  remarkable  for 
vivacity  and  brilliance  of  language. 

Hygiene  of  Pregnancy. — The  health  and  perfec- 
tion of  the  child  depend  largely  upon  the  health 
and  perfection  of  the  parents  at  the  time  of  its  con- 
ception, as  well  as  upon  the  condition  of  the  mother 
during  the  pregnancy.  Even  when  both  parents 
possess  a  strong  constitution,  but  one  or  both  of 
them  is  suffering  from  a  temporary  exhaustion  or 
malaise,  the  child  will  be  born  below  the  standard 
of  health  it  ought  to  possess.  Children  born  during 
the  first  year  of  married  life  seldom  equal  in  health 
the  children  born  of  the  same  parents  later;  they 
are  not  only  apt  to  be  sickly,  but  the  liability  to 
premature  death  is  greatly  increased.  For  this 
reason  it  is  better  that  the  first  year  of  married  life 
should  be  allowed  to  pass  without  conception  taking 
place.  A  child  begotten  in  an  intoxicated  or  de- 
praved condition  of  a  parent  may  be  depraved  itself 
in  the  same  way,  and  is  apt  to  be  feeble-minded  or 
idiotic. 

It  must  be  borne  in  mind  that  prenatal  culture 
of  some  sort  begins  at  the  time  of  conception ;  and 
that  on  the  mental  as  well  as  on  the  physical  state 
of  the  mother,  the  health  as  well  as  the  disposition 
of  the  child  will  depend  to  no  slight  extent.  The 
prospective  mother  who  constantly  gives  way  to 
her  feelings  does  a  wrong  to  her  unborn  child.     The 


124  Maternity. 

mother  is  at  this  time  more  impressionable,  more 
nervous,  and  more  irritable  than  is  natural  to  her; 
and  while  her  family  should  make  a  certain  allow- 
ance for  her  cond:tion,  she,  on  her  part,  should  not 
allow  herself  to  give  way  to  her  morbid  feelings. 
The  prospective  mother  should  not  lead  a  life  of 
self-indulgence,  on  the  one  hand,  or,  on  the  other, 
should  not  be  weighed  down  with  cares ;  she  should 
interest  herself  in  her  usual  duties,  and  be  relieved 
of  all  anxiety  possible. 

Dress. — The  clothing  must  be  loose,  and  all  com- 
pression about  the  waist  and  abdomen  must  be  es- 
pecially avoided.  If  the  woman  wears  corsets,  she 
must  take  them  off  at  once,  and  substitute  a  Ferris 
or  some  similar  hygienic  waist.  The  corset  pre- 
vents the  proper  development  of  the  abdominal  mus- 
cles, which  play  so  important  a  role  in  the  expulsion 
of  the  child  from  the  womb,  as  well  as  in  the  proper 
growth  and  development  of  the  fetus  itself.  If 
the  woman  has  already  borne  children,  and  toward 
the  end  of  the  pregnancy  the  abdomen  becomes 
pendulous,  she  will  very  materially  add  to  her  com- 
fort by  wearing  a  muslin  abdominal  bandage. 

A  woolen  undersuit,  or  undervest  and  drawers, 
with  high  neck  and  long  sleeves,  must  be  worn  win- 
ter and  summer ;  the  grade  of  the  wool  to  be  adapted 
to  the  season  of  the  year.  The  especial  necessity 
for  wearing  wool  next  the  skin  during  the  preg- 


Pregnancy.  125 

nancy  is  because  of  the  intimate  relation  between 
the  skin  and  the  kidneys.  Any  chilling  of  the  body 
at  this  time  is  apt  to  lead  to  the  congestion  of  the 
kidneys.  If  there  is  already  any  congestion  of  the 
kidneys  present,  or  any  abdominal  pain,  in  addition 
to  the  undersuit  an  abdominal  bandage  should  be 
worn.  These  bandages  come  woven  in  ribbed 
woolen,  and  fit  the  body  snugly.  This  bandage 
is  to  be  constantly  worn,  and,  of  course,  changed 
at  night.  During  the  cold  weather  'the  stockings 
should  also  be  of  wool.  Under  no  circumstances 
are  garters  allowed  to  be  worn,  as  they  form  a 
constriction  around  the  leg  and  interfere  with  the 
return  of  the  venous  blood  to  the  heart,  and  so 
increase  the  tendency  to  the  formation  of  the  vari- 
cose veins.  It  is  better  not  to  use  any  means  to 
hold  the  stockings  up ;  they  will  be  kept  sufficiently 
well  in  place  by  the  under-drawers.  Low  shoes 
should  never  be  worn  except  in  the  hottest  weather. 
It  is  of  the  greatest  importance  that  the  woman 
should  be  impressed  with  the  necessity  of  the  avoid- 
ance of  taking  cold,  since  any  lung  or  kidney  trouble 
is  a  serious  complication  of  pregnancy. 

Diet. — The  diet  is  the  same  as  that  at  any  other 
time,  only  it  is  more  necessary  to  guard  against 
anything  which  is  likely  to  cause  indigestion.  In 
other  words,  the  diet  should  be  plain,  simple,  and 
easy  of  digestion ;    nutritious  and  partaken  of  at 


126  Maternity. 

regular  intervals.  In  the  latter  part  of  pregnancy 
owing  to  the  pressure  of  the  enlarged  uterus  on  the 
stomach,  the  food  may  have  to  be  partaken  of  in 
smaller  quantities  and  at  shorter  intervals.  At  this 
time  also  the  appetite  is  abnormally  large.  Where 
it  does  not  disagree  with  the  patient,  milk  is  the 
best  adjuvant  possible  to  the  diet. 

Constipation. — Constipation  is  the  rule  of  preg- 
nancy. This  is  due  to  the  great  pressure  that  the 
enlarged  uterus  makes  on  the  bowel;  and  as  im- 
portant as  it  is  at  all  times  to  keep  the  bowels  regu- 
lar, it  is  at  this  time  more  necessary  than  ever  that 
the  woman  should  have  the  bowels  well  evacuated 
every  day.  A  retention  of  fecal  matter  in  the  body 
causes  the  reabsorption  into  the  blood  of  the  toxic 
matters,  with  the  resulting  headaches,  dizziness,  loss 
of  appetite,  and  intense  nervousness.  To  obviate 
this  tendency  to  constipation,  plenty  of  fruit  and 
vegetables  should  be  eaten,  as  well  as  cereals  if  the 
woman  is  taking  a  good  deal  of  outdoor  exercise, 
otherwise  the  latter  had  better  be  omitted.  The 
woman  should  drink  plenty  of  water  —  at  least  three 
pints  a  day;  this  acts  as  a  laxative  as  well  as  to 
flush  out  the  kidneys.  If,  in  spite  of  all  these  meas- 
ures, constipation  still  persists,  as  it  probably  will, 
a  seidlitz  powder  can  be  taken  the  first  thing  on 
rising  in  the  morning;  or  from  one  teaspoonful  to 
one  tablespoonful  of  the  effervescing  granules  of  the 


Pregnancy.  127 

phosphate  of  soda  in  a  glass  of  water,  also  to  be 
taken  on  rising  in  the  morning;  or  one-half  grain 
of  the  solid  extract  of  cascara  sagrada  night  and 
morning.  The  object  of  these  is  to  keep  the  bowels 
open,  but  purgation  must  always  be  avoided. 

Bladder  Symptoms. — If  there  is  any  irritability 
of  the  bladder,  any  scalding  on  urination,  or  a  very 
great  frequency  of  emptying  the  bladder  in  the  early 
months  of  pregnancy,  a  physician  should  be  con- 
sulted at  once;  in  the  last  months  of  pregnancy 
there  is  a  desire  to  evacuate  the  bladder  frequently, 
and  sometimes  at  the  last  there  is  an  incontinence 
of  urine,  which  is  due  to  the  descent  of  the  uterus 
and  the  great  pressure  on  the  bladder;  this  con- 
dition disappears  with  the  confinement. 

Leucorrhea. — If  this  is  present  to  any  marked 
degree,  the  vaginal  douche  should  be  continued 
throughout  the  pregnancy;  the  temperature  of  the 
douche  should  be  from  no°  to  1120  F. ;  it  must 
never  be  taken  very  hot  or  very  cold.  The  fountain 
syringe  should  be  used,  and  the  bag  should  not  be 
hung  more  than  three  feet  above  the  bed,  so  that 
there  shall  not  be  too  much  force  to  the  stream  of 
water. 

Baths. — Warm  tub-baths  may  be  taken  through- 
out the  pregnancy,  but  never  oftener  than  twice 
a  week,  and  the  woman  should  never  stay  in  the  tub 
longer  than  is  absolutely  necessary  for  the  bath, 


128  Maternity. 

as  otherwise  the  bath  is  too  enervating.  A  daily 
sponge-bath  of  cool  or  cold  salt  water  at  a  tempera- 
ture of  from  8o°  to  yo°  ¥.,  and  in  the  proportion 
of  a  pint  of  rock  or  sea  salt  to  a  gallon  of  water  is 
most  invigorating,  and  counteracts  many  of  the 
nervous  symptoms  and  promotes  sleep  and  good 
digestion.  The  temperature  of  the  room  in  which 
this  bath  is  taken  should  be  72  °  F.  Shower-baths 
cause  too  great  a  shock  to  the  nervous  system,  and 
they  as  well  as  foot-baths  must  be  prohibited.  Sitz- 
baths  at  a  temperature  from  no°  to  900  F.  may  be 
taken  just  before  retiring  throughout  the  pregnancy. 
The  frequency  and  duration  of  the  bath  as  well  as 
the  temperature  should  be  regulated  by  the  attend- 
ing physician.  In  cases  of  intense  nervousness  and 
insomnia  these  baths  have  an  excellent  sedative 
effect.  A  pregnant  woman  must  never  under  any 
circumstances  take  ocean  baths,  since  there  is  always 
great  danger  that  the  shock  of  the  waves  will  cause 
an  abortion.  Sea- voyages  should  be  avoided  be- 
cause of  the  severe  nausea  and  vomiting,  as  well 
as  the  danger  that  the  lurching  of  the  vessel  may 
cause  miscarriage. 

The  sewing-machine  is  a  tabooed  thing  for  the 
pregnant  woman,  because  of  the  jarring  of  the  pel- 
vis which  it  produces.  Sweeping  of  heavy  carpets 
is  also  injurious.  There  must  be  no  lifting  of 
heavy  pieces  of  furniture,  and  especially  no  lifting 


Pregnancy.  129 

from  the  floor,  as  it  interferes  with  the  circulation 
in  the  uterus  and  is  apt  to  produce  miscarriage. 

Driving  in  an  easy  carriage  over  smooth  roads 
is  permissible;  dogcarts,  or  any  conveyance  which 
produces  much  jolting,  must  be  avoided;  and  while 
driving  is  good,  the  woman  should  not  do  her  own 
driving,  on  account  of  the  danger  of  the  jars  that 
would  be  caused  by  the  sudden  pulling  of  the  horse 
upon  the  lines.  Horseback-riding  and  bicycling 
are,  of  course,  forbidden,  as  are  also  golf,  tennis, 
and  dancing. 

Exercise. — Exercise  in  the  open  air  should  be 
taken  every  day,  when  the  weather  is  suitable,  and 
walking  is  the  best  form  of  exercise.  The  amount 
will  be  regulated  to  some  extent  by  what  the  woman 
has  been  accustomed  to  taking,  and  it  should  always 
stop  short  of  fatigue.  The  woman  should  live  as 
much  as  possible  in  the  open  air,  and  she  should 
attend  to  her  ordinary  duties  about  the  house.  Long 
railway  journeys  are  always  objectionable. 

Hemorrhoids  or  piles  are  very  often  troublesome 
toward  the  close  of  the  pregnancy.  To  overcome 
this,  the  patient  should  lie  down  immediately  after 
the  bowel  movement,  and  remain  in  the  recumbent 
position  for  ten  or  fifteen  minutes.  In  addition, 
care  should  be  taken  to  secure  a  loose  movement 
of  the  bowels.  Should  the  piles  come  down,  appli- 
cations of  cloths  wrung  out  of  hot  water,  and  held 
9 


130  Maternity. 

well  pressed  against  the  bowel,  should  be  made; 
the  piles  should  then  be  pressed  back  until  the  finger 
feels  that  the  mass  has  been  pushed  above  the  second 
constriction  of  the  bowel,  which  is  felt  to  exist  at 
about  two  inches  above  the  sphincter  ani  muscle. 
Should  these  means  not  suffice,  the  physician  must 
be  consulted  at  once. 

Swelling  and  pain  of  the  external  genitals  and 
of  the  lower  limbs  are  best  relieved  by  the  recum- 
bent position.  Should  the  veins  of  the  legs  be  much 
enlarged  or  the  feet  swollen,  the  patient  should  have 
compression  made  by  the  wearing  of  elastic  stock- 
ings. Or  in  some  cases  a  bandage  is  sufficient;  in 
this  case  the  bandage  may  be  made  of  muslin;  it 
should  be  three  inches  wide,  and,  beginning  at  the 
toes,  should  extend  up  as  high  as  the  enlargement 
of  the  veins  continues.  This  bandage  should  be 
freshly  applied  every  morning  before  rising. 

Pain  caused  by  the  stretching  of  the  skin  may  be 
relieved  by  the  inunction  of  the  skin  with  cotton- 
seed or  cocoanut  oil.  For  severe  pain  in  the  small 
of  the  back,  rubbing  with  soap  liniment  or  alcohol 
will  be  found  useful.  . 

Mental  Occupation. — Important  as  this  always  is, 
it  is  doubly  so  now.  The  mind  should  be  constantly 
and  pleasantly  occupied,  but  no  severe  study  should 
be  indulged  in.  The  emotional  susceptibility  is  gen- 
erally somewhat  increased.     The  pregnant  woman, 


Pregnancy.  131 

quite  excitable  and  irritable,  readily  responds  to 
influences  by  which  in  the  non-gravid  condition  she 
could  not  be  affected.  Sometimes  she  feels  unusu- 
ally well,  is  intellectually  brightened  and  more 
active,  and  says  she  is  positively  happier.  At  other 
times  she  is  despondent  and  morose. 

Physiologists  admit  and  observation  proves  that 
maternal  emotions  do  affect  the  development  and 
the  exterior  of  the  fetus;  likewise  the  mental  or- 
ganization of  the  fetus  may  be  affected.  All  un- 
pleasant news,  frights,  and  physical  shocks,  also 
scenes  of  suffering  and  distress,  must  be  avoided, 
as  the  mind  is  particularly  impressionable  at  this 
time.  Around  the  patient  should  be  thrown  a 
gentle  and  protective  care,  and  she  should  be  treated 
with  the  considerate  kindness  which  her  condition 
demands.  Theatres  and  all  places  where  there  will 
be  a  large  assemblage  of  people  should  be  avoided, 
as  the  close  air  and  general  bad  ventilation  are  apt 
to  produce  vertigo  and  sometimes  attacks  of  faint- 
ing. 

Sleep. —  During  pregnancy  a  large  amount  of 
sleep  is  required ;  there  should  be  eight  hours  spent 
in  sleep  at  night,  and  one  hour  every  afternoon. 
Pregnant  women  should  never  do  any  night  watch- 
ing. There  is  unusual  necessity  for  good  ventila- 
tion during  sleep  at  this  time. 

The  Marital  Relation. — Coitus  is,  as  a  rule,  dis- 


132  Maternity. 

tasteful  to  pregnant  women.  It  is  for  the  best  in- 
terest of  the  wife  as  well  as  for  that  of  the  child  that 
all  marital  relation  should  be  suspended  at  this  time. 
Even  uncivilized  nations  have  condemned  the  privi- 
lege of  sexual  intercourse  during  pregnancy,  and 
have  visited  punishment  on  the  offender.  If  these 
relations  are  not  wholly  suspended,  they  must  at 
least  be  at  those  periods  which  correspond  to  the 
time  at  which  the  woman  would  have  been  unwell 
had  she  not  been  pregnant.  To  the  continuance  of 
these  relations  throughout  the  pregnancy  is  due 
much  of  the  suffering  of  the  wife,  not  only  then, 
but  at  the  time  of  the  labor  as  well ;  and  the  nour- 
ishment of  the  child  is  interfered  with. 

Causes  of  Miscarriage. —  Hemmorrhoids ;  strain- 
ing at  stool;  excessive  intercourse  in  the  newly 
married;  nursing;  ocean-bathing;  overexertion; 
overexcitement ;  a  fall ;  any  violent  emotion ;  anger ; 
sudden  or  excessive  joy ;  a  fright;  running;  danc- 
ing; horseback-riding;  riding  in  a  heavily  built 
carriage  over  rough  roads;  great  fatigue;  lifting 
heavy  weights;  the  abuse  of  purgative  medicines; 
disease  or  displacements  of  the  womb;  and  a  gen- 
eral condition  of  ill  health. 

The  danger  of  miscarriage  is  greatest  during  the 
first  three  months  of  pregnancy.  Miscarriage  is  a 
fruitful  source  of  disease  and  often  of  danger  to 
wives ;   it  is  said  that  thirty-seven  out  of  every  hun- 


Pregnancy.  133 

dred  pregnant  women  miscarry.  Miscarriage  is 
most  apt  to  occur  during  the  first  pregnancy;  and 
great  care  should  be  taken  to  prevent  this,  as  the 
habit  is  easily  established,  and  after  one  miscarriage 
has  occurred,  another  is  likely  to  follow,  so  that  it 
is  sometimes  with  the  greatest  difficulty  that  the 
woman  can  be  made  to  carry  the  fetus  to  full  term. 
Artificially  produced  abortions  are  not  an  infrequent 
cause  of  sterility;  the  young  wife  becomes  preg- 
nant, and  has  an  abortion  produced  because  she  is 
not  yet  ready  to  give  up  all  her  pleasures;  and 
eventually  when  she  does  become  very  anxious  to 
have  a  child  such  an  extent  of  uterine  disease  has 
been  produced  by  the  abortions  that  she  cannot 
conceive. 

To  Prevent  Miscarriage. — The  life  must  be  free 
from  all  excitement,  and  must  be  as  quiet  as  possible 
without  becoming  monotonous;  especial  care  must 
be  exercised  at  the  return  of  the  dates  for  the  men- 
strual periods. 

The  symptoms  of  miscarriage  are  a  show  of  blood, 
more  or  less  profuse,  with  intense  abdominal  pain; 
on  the  slightest  show  of  blood  the  patient  should 
go  to  bed  at  once  and  the  physician  should  be  sent 
for. 


CHAPTER  XI. 

THE  CONFINEMENT. 

Preparation  for  the  Confinement;  Signs  of  Ap- 
proaching Labor;  Symptoms  of  Actual  Labor ;  the 
Confinement-bed ;  the  Process  of  Labor. 

"  To  my  conception  one  generation  of  educated  mothers  would  do 
more  for  the  regeneration  of  the  race  than  all  other  human  agencies 
combined;  and  it  is  an  instruction  of  the  head  they  need,  and  not 
of  the  heart.  The  doctrine  of  responsibility  has  been  ground  into 
Christian   mothers   above   what   they   are  able  to  bear." 

ISABEUE    BEECHER    HOOKER. 

Preparations  for  the  Confinement. —  The  right 
time  to  engage  the  physician  who  is  to  take  charge 
of  the  woman  at  her  confinement  is  just  so  soon  as 
the  woman  knows  that  she  is  pregnant.  It  used 
to  be  argued  that,  since  giving  birth  to  children 
was  a  physiologic  process,  there  was  no  necessity 
for  the  woman  to  consult  the  physician  until  he 
was  sent  for  when  the  labor  pains  began.  Take 
the  case  of  the  woman  who  is  for  the  first  time 
pregnant ;  she  is  absolutely  at  sea ;  she  has  not  the 
least  idea  how  she  ought  to  feel,  what  she  ought  to 
do  or  to  leave  undone;  the  result  is  that  she  often 
has  a  miscarriage  which  is  the  source  of  the  greatest 

134 


The  Confinement.  135 

disappointment  to  her  husband  and  herself,  or  she 
suffers  very  unnecessarily  throughout  the  entire 
pregnancy,  has  a  difficult  labor,  and  perhaps  gives 
birth  to  a  sickly  child. 

The  educated  physician  will  explain  to  her  what 
symptoms  are  normal  and  what  are  pathologic,  and 
often  he  will  be  able  to  entirely  cure  the  latter.  It 
is  now  a  well-established  fact  that  the  most  serious 
complications  of  the  pergnancy,  and  of  the  labor 
itself  are  caused  by  severe  congestion  or  disease  of 
the  kidneys.  The  condition  of  the  kidneys  can  only 
be  determined  by  frequent  examinations  of  the 
urine ;  during  the  early  months  of  pregnancy  these 
examinations  are  made  once  a  month,  and  during 
the  last  month  they  are  made  every  week.  The 
amount  of  urine  passed  in  the  normal  condition  is 
three  pints  a  day. 

Nowhere,  perhaps,  is  the  constant  vigilance  of 
the  physician  so  well  rewarded  as  in  the  careful 
oversight  of  the  pregnant  woman.  She  goes  through 
her  entire  pregnancy  feeling  well,  and  often  the 
greatest  discomfort  that  she  suffers  is  due  to  her 
size;  her  labor  and  her  lying-in  are  normal,  and 
she  gives  birth  to  a  healthy  child. 

Engagement  of  the  Nurse. — This  is  generally  left 
to  the  physician  in  charge  of  the  case,  since  he  is 
responsible  for  the  safe  delivery  of  the  woman ;  but 
\f  the  patient  has  any  decided  choice  in  the  matter, 


136  Maternity. 

it  is  acceded  to  unless  there  should  be  some  very 
valid  objections,  and  the  physician  always  sends  the 
nurse  in  view  for  that  case  to  see  the  patient  in  order 
to  ascertain  if  she  is  personally  agreeable  to  the 
patient. 

Choice  of  Room  for  the  Confinement  and  Lying- 
in. — The  room  should  be  light,  sunny,  and  well 
ventilated ;  it  should  not  be  too  near  a  water-closet. 
In  the  city  as  quiet  a  room  as  possible  should  be 
selected,  and  one  that  is  well  removed  from  the 
rest  of  the  house,  so  that  if  necessary  perfect  quiet 
can  be  maintained.  The  room  should  be  as  cheery 
as  possible. 

The  dress  of  the  mother  during  the  lying-in  con- 
sists of  a  merino  undervest,  with  high  neck  and 
long  sleeves,  and  a  nightgown,  which  shall  be  open 
all  the  way  down  the  front.  The  gowns  should 
be  made  of  light  muslin  or  of  cambric;  and  there 
should  be  a  sufficient  number  so  that  they  may  be 
changed  every  day. 

Six  abdominal  bandages  should  be  provided. 
These  are  made  of  light  muslin,  and  they  should 
be  eighteen  inches  wide  and  long  enough  to  go  once 
and  a  third  around  the  patient's  hips  at  the  sixth 
month  of  pregnancy,  or  about  one  yard  and  a  quar- 
ter long;  they  may  be  made  straight  or  to  fit  the 
patient  at  the  sixth  month.  This  bandage  is  fas- 
tened down  the  front ;  it  is  applied  directly  after  the 


The  Confinement.  137 

labor,  and  adds  greatly  to  the  patient's  comfort 
during  the  lying-in. 

The  vulvar  pads  used  during  the  lying-in  are  the 
antiseptic  absorbent  pads  which  can  be  obtained 
at  any  place  where  surgical  dressings  are  sold ;  they 
are  made  of  absorbent  cotton,  covered  with  cheese- 
cloth, and  sterilized. 

There  must  be  a  sufficiently  generous  supply  of 
sheets  so  that  they  can  be  changed  every  day,  and 
the  drawsheet  as  often  as  may  be  required.  Noth- 
ing is  so  important  to  a  good  lying-in  as  to  have  a 
clean,  well-ventilated  room,  and  plenty  of  fresh  bed- 
linen.  Cleanliness  is  the  first  requisite  to  antisepsis, 
and  this  is  the  secret  of  avoiding  puerperal  fever. 

Articles  to  be  provided  for  the  confinement  are: 

1.  An  oblong  douche-pan  of  agate-ware. 

2.  An  agate  bed-pan. 

3.  A  bath  thermometer. 

4.  Two   pieces  of  rubber  sheeting;  one,  one 
yard  square,  and  the  other  two  yards  square. 

5.  Two  sterilized  bed-pads,  30  inches  square 
by  3  to  4  inches  thick. 

6.  Three  dozen  antiseptic  absorbent  pads.. 

7.  One  pound  of  sterilized  absorbent  cotton; 
twelve  yards  of  cheese-cloth. 

8.  Six  abdominal  bandages,  eighteen  inches 
wide,  preferably  made  to  fit  the  figure  at  the  sixth 
month  of  gestation. 


138  Maternity. 

9.  Two  hand-scrubs. 

10.  Four  ounces  of  the  tincture  of  green  soap. 

11.  Bottle  of  corrosive  sublimate  tablets. 

12.  Four  ounces  of  powdered  boric  acid. 

13.  Half  a  pint  of  good  whisky. 

14.  Two  ounces  of  aromatic  spirits  of  ammonia. 

15.  Two  ounces  of  aqua  ammonia. 

16.  One  pint  of  alcohol. 

17.  Two  tubes  sterilized  white  vaselin. 

18.  Plenty  of  large  and  small  safety-pins. 

19.  Hot-water  bag. 

20.  New  fountain  syringe,  to  hold  four  quarts; 
with  glass  nozle. 

21.  One  small  basin  for  vomited  matter. 

22.  Two  very  large  agate  basins  or  wash-bowls 
for  washing  doctor's  hands  and  for  antiseptic  solu- 
tions. 

23.  Vessel  for  after-birth. 

24.  Three  large  pitchers;  one  for  boiling  water, 
one  for  cold  boiled  water,  and  one  for  antiseptic 
solution. 

25.  Tumbler  for  boric  acid  solution  for  washing 
baby's  eyes,  with  fine  old  linen  sterilized. 

26.  One  dozen  freshly  laundered  sheets,  and  two 
dozen  towels. 

2J.  Stocking-drawers,  muslin. 
28.  Change  of  night-clothing  warmed   for  the 
mother. 


The  Confinement.  139 

29.  A  warm  blanket  to  receive  the  baby. 

30.  An  infant  bath-tub. 

31.  A  large  piece  of  oil-cloth  to  protect  the  floor.* 
Baby's    Outfit. —  Four   flannel   bandages,   to   be 

made  of  fine,  soft  flannel,  four  inches  wide,  to  go 
once  and  a  third  around  the  body.  The  edges  may 
be  pinked  or  whipped,  but  should  never  be  hemmed ; 
a  tape  is  sewed  on  double,  the  ends  passing  around 
the  body,  and  so  the  bandage  is  fastened  without 
pinning. 

Six  merino  shirts,  with  high  neck  and  long  sleeves, 
made  to  button  down  the  front. 

Cotton  diaper  napkins,  not  too  large;  old  soft 
ones  are  preferable. 

Long  merino  stockings  which  can  be  pinned  to 
the  napkin. 

Flannel  petticoats,  not  too  long;  these  may  be 
made  on  muslin  bands,  which  are  held  up  on  the 
shoulders  by  means  of  straps.  The  essential  in  all 
the  clothing  is  that  it  should  be  sufficiently  loose. 

Dress-slips  should  not  be  so  elaborate  that  they 
cannot  be  washed  and  changed  with  sufficient  fre- 
quency; and  not  so  long  that  the  baby's  feet  will 
be  hampered  in  their  movements  by  them.     All  of 

*Van  Horn  &  Co.,  Park  Avenue  and  41st  Street,  New 
York,  keep  an  obstetric  outfit,  containing  many  of  the  above 
articles,  cleansed,  sterilized,  and  packed  in  a  box  ready  for 
use,  so  that  they  remain  intact  until  needed.  The  price  of 
this  outfit  is  $16.50. 


140  Maternity. 

baby's  clothes  but  the  dress  should  be  fastened  by 
safety-pins. 

Baby's  basket  should  contain : 

1.  One  outfit  of  clothes. 

2.  One  tube  of  sterilized  tape. 

3.  A  pair  of-  blunt-pointed  scissors. 

4.  Large  and  small  safety-pins. 

5.  Pieces  of  fine  old  linen;    old  handkerchiefs 
are  the  best. 

6.  A  soft  hair-brush. 

7.  A  powder  box  and  puff,  with  talcum  pow- 
der. 

8.  Two  tubes  of  sterilized  white  vaselin. 

9.  Two  soft  towels. 

10.  Castile  soap. 

11.  Single-bulb  syringe;  so-called  "eye  and  ear 
syringe." 

12.  A  woolen  shawl  or  wrap. 

If  there  is  no  nurse  available  before  the  labor 
sets  in,  and  it  is  necessary  for  the  patient  to  see 
to  the  sterilizing  of  the  above  articles,  she  should 
first  scrub  off  all  pitchers,  basins,  and  other  utensils, 
as  well  as  the  douche-pan,  fountain  syringe,  and 
rubber  sheeting,  with  a  brush  and  hot  soap-suds; 
the  hand-scrubs  are  to  be  well  washed;  then  each 
article  should  be  pinned  separately  in  coarse  towels, 
and  put  to  boil  for  half  an  hour  in  an  ordinary 


The  Confinement.  141 

wash-boiler.  The  articles  so  boiled  are  then  dried 
without  removing  the  towels,  put  away,  and  not 
opened  till  the  time  of  the  labor. 

The  abdominal  bandages  must  be  laundried  and 
pinned  up  in  separate  towels  until  they  are  needed. 
The  cheese-cloth  must  be  laundried  and  then  ster- 
ilized. 

The  vulvar  pads  should  be  pinned  in  an  old  nap- 
kin, in  packages  of  half  a  dozen  each;  and  one 
package  is  sterilized  at  a  time  by  placing  it  in  the 
oven  until  the  outer  covering  is  scorched.  The 
linen  for  the  baby's  eyes  and  the  cheese-cloth  are 
treated  in  the  same  way ;  they  are  to  be  cut  up  into 
small  pieces  and  sterilized  as  needed. 

Signs  of  Approaching  Labor. — About  two  weeks 
before  labor  there  is  a  sinking  of  the  womb.  At 
the  beginning  of  the  ninth  lunar  month  this  was  at 
the  end  of  the  breast-bone;  it  now  descends  to  a 
point  midway  between  this  and  the  navel;  the  ab- 
domen becomes  smaller,  the  pressure  on  the  lungs 
is  relieved,  and  the  woman  breathes  more  freely. 
But  at  the  same  time  that  the  woman  is  relieved 
of  the  pressure  on  the  chest,  she  experiences  increase 
of  the  troubles  in  the  lower  extremities.  There  is 
an  increase  of  the  bladder  symptoms,  with  a  desire 
for  frequent  unrination.  Constipation  becomes  more 
troublesome,  and  there  may  be  hemorrhoids;    the 


142  Maternity. 

veins  of  the  lower  extremities  may  become  greatly 
enlarged. 

There  is  an  increased  fullness  of  the  external 
genitals  and  a  greatly  augmented  amount  of  mucous 
discharge.  There  is  a  feeling  of  anxiety  and  nerv- 
ousness, with  depression  of  spirits. 

During  the  last  two  weeks  of  pregnancy  patients 
are  apt  to  have  cramp-like  pains  in  the  lower  part 
of  the  abdomen.  These  are  often  mistaken  for 
labor  pains.  True  labor  pains  are  characterized  by 
starting  in  the  back,  extending  around  the  abdomen 
and  toward  the  pubes  and  down  the  thighs;  they 
come  at  more  or  less  regular  intervals  of  half  to 
three-quarters  of  an  hour,  and  increase  in  intensity 
with  a  decrease  in  the  intervals.  A  strong  pain  is 
apt  to  be  followed  by  two  weaker  ones.  The  so- 
called  false  pains  are  irregular  in  their  occurrence. 

Symptoms  of  Actual  Labor. — First  is  generally 
the  show ;  this  is  a  discharge  of  mucous  tinged  with 
blood ;  at  the  same  time  the  true  labor  pains  set  in. 
When  the  patient  or  nurse  is  in  any  doubt  as  to 
the  character  of  the  pains,  or  when  the  show  ap- 
pears, the  physician  should  be  summoned  at  once. 
Other  symptoms  are  frequent  desire  to  empty  the 
bladder  and  bowels,  and  a  sensation  of  shivering. 

The  Confinement-Bed. —  A  single  bed  is  much 
more  convenient,  but  it  is  rarely  found  in  a  private 
house.     The  double  bed  is  arranged  as  follows: 


The  Confinement.  143 

The  hair  mattress  is  covered  with  a  large  rubber 
sheet,  which  is  pinned  with  safety-pins  at  the  cor- 
ners and  tucked  well  under  the  mattress ;  the  rubber 
sheet  must  not  be  drawn  too  tightly  for  fear  of 
tearing*.  Over  this  comes  the  sheet,  and  over  the 
upper  half  of  the  bed,  the  draw-sheet;  this  is  a 
sheet  folded  four  double,  which  goes  across  the  bed 
so  as  to  come  under  the  hips  of  the  patient,  and  is 
tucked  under  the  mattress  at  both  sides.  The  ob- 
ject of  this  is  so  that  it  may  be  frequently  and  easily 
changed  without  disturbing  the  patient.  The  sheet, 
blanket,  and  spread  which  are  to  serve  as  a  covering 
after  delivery  are  folded  back  and  placed  on  the  left 
side  of  the  bed. 

The  lower  right-hand  corner  of  the  bed  —  the 
right  side  of  the  bed  is  that  side  which  is  toward 
the  right  hand  as  one  stands  facing  the  foot-board 
—  is  arranged  for  the  confinement ;  on  this  is  fas- 
tened the  smaller  rubber  sheet,  and  over  this  the 
sheet  is  folded,  and  both  are  fastened  down  with 
safety-pins.  The  pillow  for  the  patient  should  be 
placed  at  the  upper  and  inner  corner  of  the  square. 
After  the  delivery  the  patient  is  lifted  to  the  upper 
part  of  the  bed  and  the  temporary  dressing  is  re- 
moved. A  sheet  and  blanket  are  used  for  a  cover- 
ing during  the  confinement. 

Before  the  labor  begins  it  is  well  to  fasten  up 
the  vest  and  gown,  so  that  they  will  not  be  soiled, 


144  Maternity. 

as  it  is  important  that  the  patient  shall  be  moved 
as  little  as  possible  after  the  labor,  as  all  movements 
tend  to  increase  the  bleeding. 

The  floor  oilcloth  must  be  spread  at  the  side  of 
the  bed  which  is  made  up  for  the  confinement,  and 
should  extend  slightly  under  the  bed. 

A  bureau  in  the  room  should  contain  the  mother's 
and  baby's  clothing,  bed-linen,  towels,  and  any  other 
articles  which  will  be  needed,  all  properly  arranged. 

The  clothing  for  the  mother  and  baby  will  be 
placed  where  it  will  keep  warm,  and  the  infant  bath- 
tub will  be  in  readiness  in  case  of  sudden  need 
for  it. 

All  water  used  about  the  confinement  must  have 
been  carefully  sterilized  in  advance.  The  best  way 
to  sterilize  the  water  is  by  boiling  it  in  a  large 
wash-boiler;  whatever  vessel  is  used  must  be  scru- 
pulously clean,  and  ought  to  be  new.  The  vessel 
is  covered  over,  and  the  water  is  allowed  to  boil 
for  half  an  hour;  it  is  then,  still  covered,  set  aside 
to  cool.  There  should  be  three  gallons  each  of 
sterilized  hot  and  cold  water;  since  in  case  of  an 
emergency  there  must  be  plenty  of  water  ready 
for  use. 

The  various  articles  ordered  in  the  confinement 
outfit  will  be  at  hand  ready  for  use.  It  is  the  duty 
of  the  nurse  to  have  everything  ready  for  the  doctor 
before  his  arrival.     The  patient  should  have  a  full 


The  Confinement.  145 

warm  tub-bath,  fresh  night-clothes  put  on,  and  an 
enema  should  be  at  once  given  to  unload  the  bowels, 
and  this  even  though  there  may  have  been  a  bowel 
movement  only  a  few  hours  previously.  The  patient 
should  remain  in  bed  until  the  arrival  of  the  doctor. 
After  an  examination  has  assured  the  latter  that  all 
is  right,  she  may  be  allowed  to  go  around  the  room, 
with  a  wrapper  thrown  on  over  the  night-gown. 

Conveniently  near  the  bed  should  be  a  small  table, 
covered  with  one  or  two  freshly  laundried  towels. 
This  table  should  have  on  it  a  wash-basin,  a  hand- 
brush,  soap  and  hot  water,  an  antiseptic  solution, 
scissors,  a  ligature  for  the  navel,  and  a  suitable 
aseptic  lubricant  for  the  hands. 

The  Process  of  Labor. — The  process  of  labor  is 
divided  into  three  stages.  The  first  stage  is  that 
of  dilatation;  by  which  is  meant  the  stretching  of 
the  mouth  of  the  womb  so  that  the  child  may  pass 
through.  At  the  first  confinement  this  stage  lasts 
about  fifteen  hours;  at  subsequent  labors  the  length 
of  this  stage  is  much  shorter,  the  average  time 
being  eight  hours.  The  pains  during  this  stage 
are  sharp  and  cutting,  and  they  are  accompanied 
by  a  slight  show  of  blood.  The  patient  is  fretful 
and  nervous 

The  second  stage  of  labor  is  called  that  of  ex- 
pulsion, because  in  this  stage  the  uterus  contracts 
down  together  with  the  abdominal  muscles  to  expel 
10 


146  Maternity. 

the  child  from  the  womb  and  the  vagina  into  the 
world.  The  duration  of  this  stage  in  the  first  con- 
finement is  about  an  hour  and  a  half. 

The  third  stage  of  labor  includes  the  time  from 
the  expulsion  of  the  child  till  the  coming  away  of 
the  after-birth;  the  average  length  of  this  stage  is 
from  twenty  minutes  to  half  an  hour. 

The  average  length  of  time  for  the  first  labor  is 
seventeen  hours;  and  for  subsequent  labors  from 
eight  to  eleven  hours. 

The  bag  of  waters  is  the  sac  of  membranes  in 
which  the  child  is  inclosed.  It  contains  a  liquid  in 
which  the  child  floats;  the  object  of  the  water  is 
to  protect  the  child  from  sudden  shocks  or  any  kind 
of  injury  during  pregnancy.  During  labor  this 
membrane  with  its  contained  water  serves  as  a  di- 
lating wedge  to  assist  in  the  opening  of  the  womb, 
and  it  also  protects  the  child  from  the  direct  con- 
traction of  the  uterus  upon  it.  When  the  waters 
break  prematurely,  the  labor  is  much  longer  and 
more  tedious ;  normally  this  should  not  occur  before 
the  mouth  of  the  womb  is  fully  dilated. 

The  pains  of  the  second  stage  of  labor  are  of  a 
bearing  down  character,  and  constantly  increase  in 
force  and  frequency;  the  climax  being  reached  as 
the  head  passes  through  the  vulvar  orifice. 

A  child  usually  lies  in  the  womb  with  the  head 
downward;  the  reason  of  this  is  that  there  is  more 


The  Confinement.  147 

room  in  the  upper  part  of  the  uterus,  and  as  the 
small  parts  of  the  child  as  it  is  folded  upon  itself 
take  up  the  most  space,  they  occupy  this  position, 
while  the  head  lies  just  above  the  pubes.  The 
normal  position  of  the  child  is :  the  head  is  flexed 
on  the  chest,  the  legs  on  the  thighs  and  the  thighs 
on  the  abdomen,  and  the  hands  are  folded  across 
the  chest.  And  so  the  child  is  usually  born  head 
first. 

During  the  stage  of  expulsion  the  head  of  the 
child  is  forced  down  slightly  during  each  pain,  to 
recede  a  little  during  the  intervals  between  the  pains; 
in  this  way  the  vagina  and  its  external  orifice  are 
gradually  stretched  so  that  the  head  of  the  child 
may  pass  through  without  tearing  the  parts.  If 
the  head  is  allowed  to  pass  through  suddenly,  or 
where  the  labors  are  rapid,  as  in  the  case  of  women 
who  have  given  birth  to  several  children,  much  mis- 
chief may  be  done  by  tearing  the  soft  parts. 

After  the  birth  of  the  head  there  is  a  short  interval 
of  rest,  when  the  shoulders  are  born;  the  rest  of 
the  body  easily  slips  out;  and  with  the  expulsion 
of  the  after-birth  the  labor  is  over. 

At  the  very  beginning  of  labor  the  patient  should 
be  given  a  full  warm  tub-bath,  and  make  an  entire 
change  of  linen.  She  will  usually  prefer  to  be 
dressed  in  her  night-clothing,  over  which  during 
the  first  stage  she  may  wear  a  loose  wrapper;  a 


148  Maternity. 

sterilized  napkin  should  be  worn  over  the  vulva  dur- 
ing this  stage.  During  the  first  stage,  as  a  rule, 
the  patient  should  not  be  confined  to  bed  until  the 
dilatation  is  well  advanced;  she  is  generally  more 
comfortable  if  she  is  allowed  to  move  around  the 
room,  and  the  pains  are  thereby  advanced. 

The  only  way  in  which  the  physician  can  deter- 
mine whether  labor  has  begun  is  by  making  an  in- 
ternal examination;  and  this  will  enable  him  to  de- 
cide as  to  whether  it  is  necessary  to  remain  or  not. 

The  nurse  should  always  wear  a  wash  dress  in 
the  confinement  and  lying-in  room. 

If  the  labor  is  long,  nourishment  in  the  form  of 
beef-tea,  broths,  and  milk  may  be  given.  No  stimu- 
lants should  be  given  without  the  direction  of  the 
physician.  The  frequent  taking  of  cold  water  is 
permissible. 

At  the  beginning  of  the  labor  the  family  and 
friends  must  be  excluded  from  the  room,  and  it 
must  be  kept  as  quiet  and  as  cheerful  as  possible. 

Toilet  of  the  Patient. — The  newly  born  child  is 
received  in  a  small  blanket,  is  well  wrapped,  and 
laid  in  a  warm  place.  The  nurse  then  turns  her 
attention  to  the  mother;  the  external  genitals  and 
soiled  parts  of  the  body  are  cleansed  with  sterilized 
cheese-cloth  wrung  out  of  an  antiseptic  solution;  if 
the  body-linen  has  become  soiled,  it  is  also  changed, 
and  all  blood-stained  articles  are  removed  from  the 


The  Confinement.  149 

bed.  The  patient  is  then  carefully  lifted  up  on  the 
permanent  bed,  and  the  vulvar  pad  and  the  ab- 
dominal bandage  are  applied;  after  which  the  pa- 
tient is  allowed  to  rest. 


CHAPTER  XII. 
THE  LYING-IN. 

Management  of  the  Lying-in;  Lactation;  Nursing. 

"  'Tis  is  ourselves  that  we  are  thus  or  thus.     Our  bodies  are  our 
gardens;  to  the  which,  our   wills  are  gardeners." — "Othello." 

Management  of  the  Lying-in. — Immediately  after 
the  delivery  the  first  essential  for  the  patient  is  ab- 
solute quiet  and  rest;  the  room  must  be  kept  quiet 
and  darkened,  and  ordinarily  the  patient  is  allowed 
to  fall  into  a  light  sleep.  During  the  first  few  hours 
after  labor  the  best  position  for  the  mother  is  flat 
on  the  back,  with  only  a  small  pillow  under  the 
head.  After  the  first  twenty- four  hours  the  patient 
may  be  allowed  to  turn  on  the  side  as  she  prefers. 
Since  absolute  rest  is  the  first  requisite  for  the  pa- 
tient, she  must  be  left  alone  with  the  nurse,  who 
must  see  that  she  does  not  fall  into  too  deep  a 
sleep.  If  the  child's  cries  disturb  the  mother,  it 
must  be  taken  into  another  room. 

The  lying-in  room  must  be  kept  free  from  all 
odors,  all  soiled  clothing  must  be  at  once  removed 
from  the  room,  and  good  ventilation  must  be  in- 
sured, being  careful  to  prevent  any  drafts. 

150 


The  Lying-in.  (1 51 

While  the  patient  is  asleep,  and  after  the  baby 
has  been  attended  to,  the  nurse  should  place  all 
blood-stained  articles  in  cold  water  to  soak.  If  in 
the  city,  the  after-birth  may  be  burned  in  the  furnace 
or  range;  it  should  be  well  covered  with  coal.  In 
the  country  the  after-birth  can  be  buried  in  a  deep 
hole. 

During  the  first  two  or  three  days  the  vulvar 
dressings  should  be  changed  from  every  three  to 
six  hours,  and  at  all  times  as  often  as  they  are  soiled. 
Each  time  that  the  dressing  is  renewed  the  external 
genitals  and  their  immediate  surroundings  are  to 
be  carefully  cleansed  with  sterilized  water,  and  fin- 
ally washed  with  a  solution  of  boric  acid,  in  the 
proportion  of  one  tablespoonful  of  boric  acid  to  one 
quart  of  water.  It  is  convenient  to  keep  this  solu- 
tion mixed  and  on  hand,  as  it  takes  some  little 
time  to  prepare  it;  it  should  be  kept  in  a  strength 
double  that  which  is  desired,  so  that  it  may  be  di- 
luted with  warm  water  to  give  the  desired  tempera- 
ture. This  solution  may  be  poured  over  the  parts 
from  a  small  pitcher,  the  douche-pan  having  been 
placed  under  the  patient  before  the  washing  began. 
After  labor  the  vulva  is  very  sensitive,  so  that  while 
the  greatest  care  must  be  used  to  remove  all  clots 
of  blood  and  the  discharge,  there  must  be  no  brisk 
rubbing  of  the  parts.  No  blood-stained  linen  should 
be  permitted  to  remain  about  the  patient  or  the  bed. 


152  Maternity. 

Since  the  lying-in  woman  perspires  freely,  her 
skin  ought  to  be  frequently  cleansed  by  sponging 
with  a  weak  solution  of  alcohol  in  tepid  water ;  this 
should  be  followed  by  friction  with  a  towel  until 
the  skin  is  in  a  glow.  Cleanliness  of  the  bed  is 
promoted  by  the  use  of  a  draw-sheet,  which  is  a 
sheet  folded  to  four  thicknesses  and  placed  beneath 
the  patient's  hips  in  such  a  way  that  the  upper  edge 
of  the  sheet  shall  come  under  the  lower  part  of  the 
pillows.  Air  and  light  must  be  freely  admitted  at 
all  times  in  order  that  the  room  may  be  bright  and 
cheerful.  For  the  first  few  weeks  the  eyes  of  the 
new-born  infant  should  be  shielded  from  all  strong 
light. 

Visitors. — For  the  first  week  after  the  confine- 
ment the  patient  should  see  no  visitors.  Even  the 
husband  or  mother  should  not  remain  in  the  room 
long  at  a  time.  Nothing  of  a  disagreeable  nature 
should  be  told  to  the  patient;  and  whoever  goes 
into  the  sick-room  should  always  carry  the  most 
cheerful  manner,  as  it  is  highly  necessary  that  the 
patient  should  be  kept  mentally  as  well  as  physically 
quiet  at  this  time. 

Diet. — For  the  first  twenty-four  hours  the  diet 
must  be  restricted  to  liquids,  and  in  most  cases 
nothing  is  given  until  the  patient  has  had  a  few 
hours'  rest.  The  first  thing  that  is  given  to  the 
patient  should  be  a  cup  of  warm  milk  or  tea.    Milk 

T/.^O';;  iO    5(5.3  J  JO  5 


The  Lying-in.  r53 

is  the  best  diet;  this  may  be  varied  with  beef-tea, 
bouillon,  mutton  or  chicken  broth;  any  of  these 
broths  may  be  made  with  rice  or  barley  to  vary 
the  flavor,  but  these  must  not  be  given  to  the  patient. 
The  patient  should  have  six  ounces  of  the  liquid 
every  two  hours  during  the  day  and  every  three 
hours  during  the  night. 

On  the  second  day  bread  well  toasted  through 
may  be  added  to  "any  of  the  liquids.  On  the  third 
day  stewed  or  baked  apples  should  be  added  to  the 
diet.  On  the  fourth  day,  and  from  this  on,  the 
patient  will  have  regular  meals,  but  the  diet  must 
be  a  plain  one.  For  breakfast,  stale  bread,  a  soft- 
boiled  egg,  fruit,  and  a  cup  of  tea,  not  too  strong. 
For  dinner,  which  should  always  be  given  in  the 
middle  of  the  day,  an  oyster-stew  or  clam  broth,  a 
lamb  chop,  or  a  very  small  piece  of  beefsteak  or 
chicken;  but  with  these  there  must  be  no  gravies 
or  dressings;  a  potato  baked  in  the  skin;  raw  to- 
matoes, if  in  season;  apple  sauce  or  cranberry; 
celery;  junket,  plain  corn-starch,  lemon  jelly,  plain 
cup-custard.  From  this  list  the  diet  must  be  ar- 
ranged so  as  to  give  as  much  variety  as  possible 
from  day  to  day.  Midway  between  breakfast  and 
dinner,  and  again  in  the  middle  of  the  afternoon, 
the  patient  should  have  a  glass  of  milk.  The  diet 
should  be  generous,  but  simple. 

Urination. —  The  feeble  condition  of  the  bladder 


1 54  Maternity. 

in  the  first  few  hours  after  delivery  frequently  leads 
to  the  retention  of  urine.  Owing  to  the  copious 
secretion  of  urine  which  is  so  common  at  this  time, 
painful  and  injurious  distention  of  the  bladder  may 
result.  The  patient  should  therefore  endeavor  to 
pass  her  urine  in  at  least  six  hours  after  labor, 
whether  she  feels  any  inclination  to  do  so  or  not; 
the  sound  of  running  water  or  warm  fomentations 
over  the  bladder,  warm  water  in*  the  douche-pan, 
and  moderate  pressure  applied  by  the  hand  over 
the  suprapubic  region,  are  often  effective  in  accom- 
plishing the  desired  result.  If  all  these  means  fail, 
the  catheter  must  be  used  as  the  last  resort.  Dur- 
ing the  entire  lying-in  the  bladder  should  be  emptied 
every  six  hours. 

Evacuation  of  the  Bozvels. —  There  should  be  an 
evacuation  of  the  bowels  in  from  twenty-four  to 
thirty-six  hours  after  the  labor.  For  this  purpose 
a  seidlitz  powder  may  be  given,  or  the  liquid  citrate 
of  magnesia.  If  this  does  not  suffice,  an  enema  of 
warm  water,  to  which  a  little  soap  or  two  teaspoon- 
fuls  of  glycerin  have  been  added,  may  be  given. 
Two  pints  of  water  should  be  prepared ;  the  patient 
will  retain  as  much  as  she  comfortably  can,  and 
as  long  as  she  can.  The  bowels  should  be  opened 
daily  after  the  first  day. 

After-pains  are  caused  by  the  same  physiologic 
process  that  causes  labor  pains  —  namely,  by  the 


The  Lying-in.  155 

contractions  of  the  uterus.  After  the  first  confine- 
ment the  after-pains  are,  as  a  rule,  not  severe;  at- 
tention to  the  regular  emptying  of  the  bladder  and 
bowels  also  lessens  the  severity  of  the  after-pains; 
these  pains  seldom  last  after  the  second  day. 

The  Lochia. —  The  discharges  of  the  mother  con- 
tinue for  about  two  weeks,  and  are  called  lochia. 
For  the  first  twenty-four  hours  they  are  pure  blood ; 
the  second  and  the  third  day  they  are  of  the  char- 
acter of  bloody  water;  from  the  fourth  to  the  sixth 
day  they  have  a  greenish-yellow  color,  and  from 
the  tenth  to  the  twelfth  day  they  become  pure  white. 
Soiled  napkins  and  dressings  should  never  be  al- 
lowed to  remain  in  the  patient's  room. 

Duration  of  the  Lying-in. — This  lasts  for  six 
weeks.  During  this  time  the  organs  of  generation 
are  returning  to  their  normal  size  and  condition. 
In  order  that  the  woman  may  be  in  the  best  con- 
dition possible  at  the  end  of  this  time,  it  is  essential 
that  for  the  first  two  weeks  she  should  remain  in 
bed ;  and  so  long  as  there  is  any  blood  in  the  dis- 
charge the  woman  should  not  be  allowed  to  sit  up. 
The  first  sitting  up  should  be  in  bed,  the  patient 
being  supported  by  a  bed-rest.  During  the  second 
two  weeks  the  patient  may  be  allowed  to  divide  her 
time  between  the  bed  and  the  couch;  in  the  latter 
part  of  this  time  she  may  be  allowed  to  go  around 
her  room  a  very  little ;  and  for  two  weeks  more  she 


156  Maternity. 

should  remain  on  the  same  floor.  The  first  sitting 
up  should  not  last  more  than  half  an  hour.  Getting 
up  and  going  around  too  soon  after  the  confine- 
ment, "  being  too  smart,"  is  one  of  the  most  pro- 
lific sources  of  falling  of  the  womb,  and  all  manner 
of  uterine  trouble,  by  which  the  general  health  of 
the  woman  is  greatly  impaired. 

Lactation. — If  it  is  at  all  possible,  every  mother 
should  nurse  her  own  child ;  in  the  interests  of  both 
the  mother  and  the  child.  So  far  as  the  mother  is 
concerned,  the  process  of  lactation  is  beneficial  be- 
cause it  hastens  the  return  of  the  uterus  to  its  normal 
size.  Wet-nurses  are  known  tyrants,  and  if  the 
quality  of  the  milk  has  anything  to  do  with  the 
disposition  of  the  child,  as  is  believed  to  be  the 
case,  the  idea  is  distasteful  of  having  a  woman  who 
belongs  to  the  lower  classes  provide  nourishment 
for  your  child;  and  artificial  feeding  is  one  unmiti- 
gated trouble. 

A  deficiency  of  the  quantity  or  the  quality  of  the 
mother's  milk  can  generally  be  remedied  by  the 
diet  and  attention  to  the  health  of  the  mother;  if 
the  deficiency  in  quantity  persists,  the  mother's  milk 
can  be  supplemented  by  artificial  feeding. 

There  may  exist  certain  conditions  of  the  mother 
in  which  nursing  her  own  infant  would  be  inadvis- 
able or  even  impossible.  Syphilis  contracted  late  in 
the  pregnancy,  and  tuberculosis,  are  contraindica- 


The  Lying-in.  157 

tions,  owing  to  the  danger  of  the  mother  infecting 
the  child.  Inversion  of  the  nipples,  their  excoria- 
tion, or  persistent  sensitiveness  may  make  it  impos- 
sible. In  marked  general  debility  of  the  mother 
from  any  cause  whatever,  it  would  be  injurious  to 
the  mother  and  the  child. 

After  the  mother  and  the  new-born  infant  have 
had  some  hours  of  rest  and  sleep,  it  is  advisable  to 
apply  the  child  to  the  breast,  to  receive  by  this  first 
effort  the  small  quantity  of  milk  which  is  an  especial 
provision  to  act  as  a  natural  purge  and  to  start  the 
bowels  of  the  child  into  a  healthy  activity ;  this  also 
excites  the  milk  glands  to  secretion.  The  mother's 
milk  in  full  supply  may  be  expected  in  from  forty 
to  sixty  hours  after  delivery. 

Nursing. — When  the  mother's  nipples  are  of  the 
normal  size  and  well  formed,  the  healthy  infant 
instinctively  suckles  at  once  when  placed  at  the 
breast,  but  sometimes  it  has  to  be  taught ;  by  squeez- 
ing out  a  few  drops  of  milk  to  wet  the  nipple,  the 
child  will  usually  take  hold,  or  a  little  sugar  and 
water  may  be  put  on  the  nipple;  a  little  patience 
and  tact  are  all  that  is  necessary  to  insure  success. 
But  the  infant  must  be  taught  to  nurse  at  once  be- 
fore the  breasts  become  engorged  with  milk. 

Under  ordinary  circumstances  the  child  is  to  be 
kept  at  the  breast  for  one  year.  But  if  within  this 
time  the  menstrual  period  should  recur  and  be  pro- 


158  Maternity. 

fuse,  or  should  the  woman  again  become  pregnant, 
the  quality  of  the  milk  becomes  poor,  and  necessi- 
tates the  immediate  weaning  of  the  child ;  the  char- 
acter of  the  milk  is  also  altered,  and  even  its  secre- 
tion may  be  checked.  Nervous  agitation  may  so 
alter  the  quality  of  the  milk  as  to  make  it  poisonous. 
A  fretful  temper,  fits  of  anger,  grief,  and  sudden 
terror  not  only  lessen  the  quantity  of  the  milk,  but 
render  it  thin  and  unhealthful,  inducing  disturbances 
of  the  child's  bowels,  diarrhea,  and  so  forth. 

Position  of  the  Mother  When  Nursing. —  When 
in  bed  in  the  recumbent  position,  the  mother  should 
lie  on  that  side  from  which  the  infant  is  going  to 
nurse;  when  up,  the  mother  should  sit  erect. 

Care  of  the  Nipples. —  Immediately  after  each 
nursing  the  nipples  should  be  washed  off  in  a  satu- 
rated solution  of  boric  acid  in  cold  water,  and  dried 
with  a  soft  cloth.  If  they  are  disposed  to  crack, 
anoint  them  with  cocoa-butter  immediately  after 
each  cleansng.  If  the  skin  of  the  nipple  is  very 
sensitive,  a  nipple-shield  should  be  used  for  the  first 
few  days;  or  should  the  nipple  become  sore  at  any 
time,  the  shield  can  be  resorted  to.  The  nipple- 
shield  must  fit  tightly;  the  best  ones  are  made  of 
glass  with  a  rubber  tip.  In  the  intervals  of  nursing 
the  nipple-shield  should  be  kept  in  cold  water  after 
it  has  been  thoroughly  cleansed  by  being  brushed 
on  both  sides. 


The  Lying-in.  159 

The  breasts  are  sometimes  distended  from  an 
over-secretion  of  milk;  this  is  relieved  by  saline 
cathartics,  by  abstinence  from  liquids,  and  by  the 
use  of  a  compression  breast  bandage.  This  is  made 
of  a  straight  piece  of  muslin,  with  a  shallow  notch 
cut  in  one  edge  for  the  neck,  and  a  deep  one  for 
each  arm;  the  bandage  is  closely  applied  over  the 
breasts,  and  the  ends  pinned  in  front;  it  is  also 
pinned  over  the  shoulders. 

In  debilitated  women  the  supply  of  milk  may 
be  insufficient;  the  most  reliable  evidence  of  this 
is  the  fact  that  the  infant  ceases  to  gain  in  weight. 


CHAPTER  XIII. 

THE  NEW-BORN  INFANT. 

The  Infant's  Toilet;  the  Crib;  Feeding  of  Infants; 
Artificial  Feeding;  the  Wet-nurse;  Characteristics 
of  Healthy  Infants;  the  Stools;  Constipation;  Uri- 
nation; Dentition. 

"  O  thou  child  of  many  prayers, 
Life  hath  quicksands;    life  hath  snares." 

— Longfellow. 

The  Infant's  Toilet. — So  soon  as  the  mother  has 
been  made  comfortable,  the  toilet  of  the  infant  is 
attended  to.  This  should  be  made  near  the  register 
or  stove ;  and  the  lap  of  the  nurse  should  be  covered 
with  a  small  flannel  blanket.  The  baby's  body  will 
be  found  to  be  covered  over  with  a  white,  greasy, 
somewhat  cheesy  substance;  some  sort  of  grease  is 
needed  for  its  removal ;  rendered  lard,  sweet  oil,  and 
lanolin  are  the  best;  vaselin  is  less  effective.  All 
of  this  cheesy  substance  must  be  at  once  removed; 
the  most  difficult  parts  will  be  in  the  folds  and 
creases.     The  nurse  should  grease  the  palms  of  her 

160 


The  New-born  Infant.  161 

hands,  then  take  the  head  of  the  child  between  them, 
and  thoroughly  grease  it;  particular  attention  must 
be  given  to  the  ears ;  then  come  the  neck,  shoulders, 
arms,  chest  and  back,  groins,  external  genital  or- 
gans, and  lower  extremities.  After  the  child  has 
been  thoroughly  gone  over,  the  grease  should  be 
rubbed  off  with  a  soft  towel. 

A  rectal  injection  of  one  tablespoon ful  of  warm 
water  is  given  at  once  to  unload  the  bowels  of  the 
meconium;  this  generally  acts  before  the  baby's 
toilet  is  completed.  The  meconium  is  the  first  dis- 
charge from  the  infant's  bowels  after  birth,  and 
that  which  had  collected  in  the  intestines  during 
the  pregnancy. 

The  Baby's  Bath. — The  baby's  bath-tub  is  filled 
about  one-third  full  of  water  at  a  temperature  of 
ioo°  F.,  tested  by  the  thermometer.  The  baby  is 
then  gradually  immersed  in  the  water,  with  the  ex- 
ception of  the  head;  this  is  supported  on  the  left 
wrist  of  the  nurse,  which  passes  under  the  infant's 
neck,  while  her  hand  grasps  the  left  shoulder;  with 
the  right  hand  the  nurse  quickly  rubs  over  the  child's 
head  and  body;  the  entire  bath  should  not  occupy 
over  five  minutes.  The  infant  is  then  lifted  out 
into  the  lap  of  the  nurse,  on  which  is  spread  a  soft, 
warm  towel,  with  which  it  is  carefully  dried.  One 
of  the  important  points  in  giving  the  infant  its  bath 

is  to  be  sure  that  the  groins,  arm-pits,  and  genitals 
ii 


1 62  Maternity. 

are  thoroughly  well  dried;  otherwise  excoriation  at 
these  parts  is  sure  to  occur. 

After  this  a  daily  tub-bath  is  given  in  the  same 
way ;  soap  is  rarely  needed ;  when  it  is,  castile  soap 
should  be  used;  its  constant  use  is  not  necessary 
and  would  only  irritate  the  skin.  These  daily  baths 
strengthen  the  nervous  system  and  prevent  coughs 
and  colds.  The  bath  should  be  given  during  the 
morning,  one  hour  after  feeding,  and  should  not 
last  more  than  five  minutes.  The  mother  herself, 
just  as  soon  as  she  is  able  to  go  around,  should 
superintend  the  bath;  in  this  way  she  is  assured 
that  it  properly  given,  and  will  also  recognize  any 
incipient  affection  of  the  child.  These  daily  baths 
should  be  continued  till  the  child  is  four  years  old. 
Powder  is  not  essential ;  but  if  it  is  desired,  a  plain 
talcum  powder  may  be  used. 

The  Dressing  of  the  Cord. — After  the  bath  the 
ligature  which  was  tied  around  the  cord  at  the  birth 
of  the  child  will  be  found  slightly  loosened;  this 
should  first  be  made  tight,  and  then  the  cord,  dou- 
bled back  on  itself,  should  be  tied  by  the  ends  of 
the  same  ligature.  A  square  of  soft  sterilized  linen 
or  gauze  is  slit  up  to  its  center ;  the  cord  is  allowed 
to  pass  through  this  slit,  which  looks  toward  the 
child's  right ;  the  stump  of  cord  is  laid  on  the  left 
and  the  ends  of  gauze  are  folded  over  this;  the 
whole  is  kept  in  place  by  the  abdominal  bandage. 


The  New-born  Infant.  163 

As  there  is  some  exudation  from  the  cord,  it  is 
necessary  to  change  these  dressings  twice  a  day; 
as  this  exudation  is  of  a  somewhat  gluey  nature, 
it  will  be  found  that  the  dressings  stick  to  the  cord. 
In  removing  the  gauze  great  care  must  be  used  not 
to  make  any  traction  on  the  cord;  when  the  infant 
is  placed  in  the  bath,  the  water  loosens  the  dressing 
and  it  falls  off  in  the  water ;  at  other  times  it  must 
be  removed  with  the  greatest  care.  There  should 
never  be  any  odor  about  the  cord;  it  usually  drops 
off  about  the  fifth  day. 

The  process  of  ulceration  by  which  the  cord  falls 
off  leaves  an  open  surface  on  the  child's  body  which 
offers  an  avenue  for  septic  infection.  Great  care 
must  therefore  be  taken  that  the  nurse's  hands  or 
anything  which  comes  in  contact  with  this  surface 
should  be  perfectly  clean.  The  dressings  used  must 
be  thoroughly  antiseptic. 

Care  should  be  used  not  to  fasten  the  abdominal 
bandage  too  tightly ;  the  bath  is  given  on  an  empty 
stomach,  and  allowance  should  be  made  for  this; 
the  binder  should  be  loose  enough  to  allow  two  or 
three  fingers  to  easily  slip  under  it. 

The  Meconium. — The  first  discharge  that  comes 
from  the  bowels  is  of  a  dark,  greenish  color,  and 
should  come  away  during  the  first  twenty-four 
hours;  if  it  does  not,  the  baby  may  suffer  a  good 
deal  of  pain,  and  an  enema  of  warm  water  must 


164  Maternity. 

be  given.  As  this  substance  is  very  difficult  to  be 
washed  out  of  napkins,  the  first  ones  used  should 
be  old  and  afterward  be  burned. 

Cleansing. — Every  time  the  napkin  needs  to  be 
changed,  even  if  it  is  only  wet,  the  baby  should  be 
washed  with  warm  water.  A  napkin  should  never 
be  used  twice  without  washing;  it  chafes  the  child, 
and  it  is  an  unsafe  as  well  as  a  filthy  practice;  the 
napkin  must  always  be  removed  as  soon  as  it  is 
wet. 

The  Infanfs  Toilet. — After  the  application  of  the 
binder  and  napkin,  comes  the  undervest ;  the  fingers 
of  the  nurse  are  passed  up  through  the  sleeve  to 
seize  the  infant's  hand  and  pull  it  through ;  as  soon 
as  it  gets  a  little  older  the  child  will  grasp  a  finger 
laid  in  its  palm,  which  greatly  facilitates  this  part 
of  the  toilet.  The  stockings  are  next  put  on  and 
pinned  with  safety-pins  to  the  napkin;  then  comes 
the  petticoat,  the  band  of  which  is  also  loosely  fas- 
tened with  safety-pins,  and  with  the  slip  the  toilet 
is  complete.  All  the  clothing  should  be  changed 
night  and  morning. 

The  eyes  and  mouth  should  be  washed  out  with 
separate  pieces  of  gauze  or  old  linen.  For  the 
mouth,  a  small  piece  of  cloth  wet  in  warm  water 
is  wrapped  around  the  little  finger  of  the  right  hand, 
going  into  the  left  angle  of  the  baby's  mouth  and 
coming  out  at  the  right,  going  between  the  gums 


The  New-born  Infant.  165 

and  cheeks  as  well  as  over  the  tongue.  This  pro- 
cedure should  be  gone  through  with  every  time 
preceding  and  following  the  nursing,  and  in  this 
way  the  milk  is  prevented  from  souring  in  the 
mouth,  and  the  digestion  is  kept  in  good  condition. 
A  sore  mouth  in  a  baby  indicates  carelessness  on 
the  part  of  the  nurse. 

A  soft  hair-brush  may  be  used,  but  the  scalp  is 
too  tender  to  permit  the  use  of  a  comb. 

After  the  toilet  has  been  completed,  the  baby  is 
laid  in  its  crib,  on  the  right  side  of  the  body,  and 
warmly  covered.  The  weaker  the  baby,  the  more 
attention  must  be  paid  to  the  external  warmth.  It 
may  be  necessary  to  place  a  warm-water  bottle  in 
the  crib,  but  this  must  never  touch  the  infant. 

The  Crib. — The  infant  must  have  its  own  crib, 
without  rockers,  and  it  must  on  no  account  be  put 
to  sleep  in  the  same  bed  with  its  mother.  In  its 
early  life  it  should  never  be  taken  out  of  its  crib 
except  to  be  fed,  to  have  its  clothing  changed,  or 
to  be  bathed.  There  should  be  no  holding  on  the 
lap,  no  dangling,  no  carrying  or  fussing  over  the 
new-born  infant;  and  the  more  the  baby  is  let 
alone,  the  better  and  healthier  it  will  be.  If  baby 
cries,  look  at  once  to  see  if  it  needs  a  fresh  napkin ; 
if  not,  if  any  pins  are  sticking  into  it,  if  the  cloth- 
ing is  possibly  too  tight;  if  none  of  these  things 
are  wrong,  give  it  a  sup  of  water  and  turn  it  over 


1 66  Maternity. 

on  the  other  side.  The  baby  often  becomes  restless 
by  sleeping  for  several  hours  in  the  same  position. 
But  on  no  account  take  the  infant  up  out  of  its 
crib  simply  because  it  cries. 

Cheerfulness  and  good  nature  on  the  part  of  the 
infant  are  dependent  on  its  general  good  health. 
A  healthy  infant  should  not  have  colic,  but  if  such 
is  the  case,  there  is  a  peculiar  look  of  distress  on  the 
face,  which  indicates  that  the  child  is  in  pain ;  what 
is  needed  is  warmth  or  medication  according  to  the 
severity  of  the  case,  but  never  floor  walking.  Begin 
the  latter  procedure,  and  you  may  hope  to  keep  it 
up  for  several  years. 

Ventilation. — The  air  is  sometimes  vitiated  for 
children's  uses  in  various  ways;  their  nervous  sus- 
ceptibilities are  greater  than  those  of  older  people. 
A  very  little  odor  of  tobacco  may  cause  nausea  and 
discomfort  to  an  infant  in  arms.  The  atmosphere 
of  the  room  should  be  sweet  and  pure  and  unscented. 
All  scents  and  perfumes  affect  the  nervous  system, 
and  by  constant  excitation  do  it  damage.  A  bou- 
quet of  flowers  renders  the  air  of  a  closed  room  too 
heavy. 

Feeding  of  Infants. — During  the  day  the  infant 
should  be  put  to  the  breast  once  every  two  hours, 
and  once  every  three  hours  during  the  night.  This 
interval  of  time  between  the  feeding  is  necessary 
in  order  that  there  may  be  sufficient  time  given  for 


The  New-born  Infant.  167 

digestion  to  take  place.  Regurgitation  of  milk 
soon  after  feeding  is  a  sign  that  the  stomach  has 
been  overfilled.  As  the  infant  usually  falls  asleep 
after  nursing,  it  is  necessary  to  waken  it  up  at  the 
time  for  the  next  nursing,  as  good  digestion  depends 
upon  regularity  of  feeding. 

For  the  first  nursing  the  infant  may  be  put  to  the 
breast  in  from  two  to  six  hours  after  the  labor  if 
the  mother  is  sufficiently  rested ;  from  ten  to  twenty 
minutes  is  long  enough  for  each  nursing.  Before 
each  nursing  the  nipples  should  be  carefully  washed 
off  with  a  solution  of  boric  acid.  The  first  secre- 
tion of  the  breasts  is  laxative;  that  is,  it  acts  on 
the  bowels,  and  makes  is  unnecessary  to  give  the 
infant  anything  to  take  for  this  purpose.  The 
breasts  should  be  used  alternately  in  feeding  the 
infant,  as  this  allows  a  longer  time  for  the  accumu- 
lation of  the  milk.  For  the  first  few  days  the 
infant  needs  very  little  food,  and  the  mother's  milk 
is  generally  sufficient. 

The  infant  should  be  given  a  teaspoonful  of  cool 
water  to  drink  two  or  three  times  a  day,  as  the 
milk  does  not  quench  the  thirst.  The  water  should 
be  sterilized  by  boiling,  and  be  kept  in  an  air-tight 
flask. 

At  the  end  of  the  third  month  the  intervals  of 
nursing  for  the  daytime  should  be  three  hours,  and 
the  last  nursing  at  night  should  be  at  eleven  o'clock, 


1 68  Maternity. 

and  the  first  nursing  in  the  morning  at  five  o'clock ; 
thus  allowing  the  mother  an  interval  of  six  hours 
of  unbroken  sleep. 

The  best  evidence  of  the  proper  nutrition  of  the 
child  is  a  progressive  gain  in  weight.  The  child 
should  be  weighed  every  week.  A  loss  of  a  few 
ounces  usually  takes  place  during  the  first  few  days 
after  birth,  so  that  the  child  does  well  if  at  the  end 
of  the  first  week  it  weighs  as  much  as  it  did  at  birth. 
After  the  first  week  the  weekly  gain  should  not  fall 
below  five  ounces. 

The  Wet-nurse. — When  the  mother  for  any  rea- 
son whatever  is  not  able  to  nurse  her  child,  the  best 
substitute  is  a  wet-nurse.  Before  she  is  employed 
the  wet-nurse  should  always  be  carefully  examined 
by  a  physician  to  insure  her  freedom  from  disease. 
The  best  age  is  between  twenty  and  thirty  years, 
and  the  age  of  the  child  of  the  nurse  should  be  at 
least  within  a  month  of  that  of  the  child  to  be 
nursed.  The  best  sign  of  the  good  health  of  the 
nurse  and  of  the  condition  of  her  milk  is  furnished 
by  the  health  of  her  own  child.  The  breasts  should 
be  well  formed  and  the  nipple  of  good  shape.  It  is 
well,  if  possible,  to  get  a  woman  who  has  borne 
several  children,  as  she  will  understand  the  care  of 
the  child  better.  No  woman  who  is  not  perfectly 
healthy  is  fit  to  be  a  wet-nurse;   and  even  after  she 


The  New-born  Infant.  169 

has  been  engaged  her  health  and  her  habits  must-be 
watched  over. 

Artificial  Feeding. — The  first  requisite  in  artificial 
feeding  is  that  the  milk  shall  be  made  to  correspond 
as  nearly  as  possible  to  that  of  the  mother.  For 
this  purpose  the  following  formula,  prepared  by 
Rotch,  of  modified  cow's  milk  is  considered  the 
best: 

Milk 2     ounces 

Cream 3     ounces 

Water   10     drams 

Milk-sugar   634  drams 

Lime-water   1      ounce 

To  make  one  pint  of  the  mixture  for  use  in  the  twenty- 
four  hours,  take  the  milk  and  cream  as  soon  as  it 
comes  in  the  morning,  and  mix  as  above  directed. 

No  less  important  than  the  correct  proportions 
of  the  ingredients,  is  freedom  from  disease  germs 
and  bacteria  of  putrefaction.  Complete  steriliza- 
tion is  possible  by  prolonged  boiling ;  but  experience 
has  proved  that  under  prolonged  exposure  to  a 
temperature  near  the  boiling-point  certain  changes 
take  place  in  the  albuminoids  of  the  milk  which 
greatly  impair  its  digestibility.  Full  sterilization 
of  milk  for  infant  feeding  has  therefore  practically 
been  abandoned.  It  has  been  found  that  milk 
heated  to  1670  F.  for  twenty  minutes,  and  promptly 
chilled  by  placing  on  ice,  remains  practically  sterile 


1 70  Maternity. 

for  twenty-four  hours,  and  it  is  spared  the  injurious 
changes  which  take  place  at  a  higher  temperature. 
This  process  is  known  as  Pasteurization.  The  Ar- 
nold steam  sterilizer  affords  a  convenient  method  of 
sterilizing;  if  used  with  the  cover  removed,  the 
steam  chamber  being  open,  the  temperature  of  the 
steam  chamber  does  not  exceed  1700  F. 

It  is  claimed  that  in  the  Arnold  steam  sterilizer, 
with  the  use  of  a  suitable  gas  stove,  the  water  begins 
to  boil  at  the  end  of  two  minutes  after  the  gas  is 
lighted.  A  four-ounce  bottle  of  milk  at  an  initial 
temperature  of  700  F.  in  the  open  steam  chamber 
attains  a  temperature  of  1700  in  just  one  hour.  An 
exposure  of  about  one  hour  and  twenty  minutes 
in  the  steam  chamber  is  therefore  necessary  for  the 
Pasteurization. 

The  rules  for  sterilizing  are  as  follows : 

First,  clean  the  bottles  thoroughly;  then  place 
them  in  cold  water,  which  is  allowed  to  come  to  boil 
and  boiled  for  ten  minutes. 

Second,  fill  each  with  the  milk  you  wish  to  use; 
put  in  the  rubber  cork  without  the  glass  plug;  this 
leaves  a  small  opening  in  the  rubber  cork;  set  the 
bottle  in  the  basket,  then  in  the  boiler. 

Third,  set  in  the  refrigerator  until  needed  for  use. 

Fourth,  when  wanted  for  use,  place  a  bottle  of 
the  milk  so  prepared  in  the  tin  mug  which  accom- 
panies the  sterilizer;    fill  the  mug  with  hot  water 


The  New-born  Infant.  171 

to  the  height  of  the  milk  in  the  bottle,  heat  the  milk 
to  the  temperature  of  99  °  F.,  remove  the  rubber 
cork  and  put  on  the  nipple,  when  it  is  ready  for  use. 

Fifth,  cleanse  the  bottle  immediately  after  using; 
throw  away  any  milk  that  has  not  been  used. 

Sixth,  if  the  steaming  process  is  preferred,  place 
the  basket  without  the  bottles  in  the  boiler,  fill  the 
water  up  to,  but  not  above,  the  bottom  of  the  basket, 
place  the  bottles  in  the  basket,  and  proceed  as 
before. 

It  is  important  that  the  milk  should  be  sterilized 
or  Pasteurized  as  soon  as  it  is  served  in  the  morning. 
Each  bottle  must  be  thoroughly  washed  as  soon  as 
it  is  emptied.  Milk  sterilized  in  this  way  will  keep 
for  days  without  spoiling,  as  it  is  hermetically  sealed 
and  all  the  unhealthy  germs  have  been  removed. 

The  most  exact  method  for  the  artificial  feeding 
of  infants,  and  that  which  most  nearly  approaches 
the  mother's  milk,  is  that  used  by  the  "  Walker- 
Gordon  Laboratory,"  branches  of  which  are  to  be 
found  in  many  of  the  large  cities. 

Not  only  is  the  greatest  care  taken  that  the  milk 
used  shall  be  pure  and  sterilized  ready  for  use,  but 
these  laboratories  are  equipped  by  special  machinery 
which  separates  the  important  elements  of  the  milk 
—  namely,  the  fat,  the  milk-sugar,  and  the  proteids. 
So  that  the  physician  can  modify  the  proportions  of 
these  various  ingredients  of  the  milk  to  meet  the 


172  Maternity. 

necessity  of  the  age  and  requirements  of  the  infant. 

When  the  milk  contains  too  little  sugar,  the  infant 
does  not  gain  as  rapidly  in  weight  as  it  would  other- 
wise do  Too  much  sugar  in  the  milk  is  indicated 
by  colic,  thin,  green,  or  acid  stools,  or  eructations 
of  gas  from  the  stomach. 

An  excess  of  fat  in  the  milk  is  indicated  by  vom- 
iting; too  little  fat  causes  constipation  with  dry 
hard  stools.  Proteids  in  excess  are  a  prolific  cause 
of  colic  and  also  of  diarrhea. 

Prescription  blanks  are  furnished  the  physician, 
who  fills  out  the  percentages  of  fat,  milk-sugar, 
proteids,  and  alkalinity,  to  suit  the  age,  weight,  and 
general  condition  of  the  child.  He  orders  also  the 
amount  to  be  given  at  each  feeding,  and  the  number 
of  feedings  to  be  given  in  the  twenty-four  hours. 
Each  bottle  contains  just  the  amount  to  be  given 
at  one  feeding.  All  that  the  mother  needs  to  do 
is  to  place  the  bottle  in  a  receptacle  containing  warm 
water,  until  the  milk  has  attained  a  temperature 
of  990  F.,  remove  the  cotton  stopper,  and  put  on 
the  nipple,  when  it  is  ready  for  use. 

The  Nursing  Bottle. — This  should  be  of  clear 
glass,  with  a  rounded  bottom,  and  of  such  a  shape 
as  is  easy  to  clean ;  so  .that  no  particles  will  cling 
around  a  corner  which  cannot  be  reached.  The 
graduated  bottle  is  the  most  convenient,  as  it  enables 
the  quantities  of  each  of  the  materials  used  in  the 


The  New-born  Infant.  173 

preparation  of  the  feeding  to  be  mixed  in  the  bottle, 
doing  away  with  the  trouble  of  measuring  before 
putting  into  the  bottle. 

Rubber  Nipples. — Two  nipples  should  be  kept  for 
alternate  use,  and  no  nipple  should  be  used  longer 
than  two  weeks.  A  soft  rubber  of  conical  shape  is 
best,  with  an  opening  at  the  top  which  is  not  too 
large,  so  that  the  milk  will  not  flow  through,  as 
it  is  desirable  that  the  child  should  obtain  the  milk 
by  suction.  So  soon  as  the  feeding  is  over,  the 
nipple  should  be  removed  from  the  bottle,  and 
brushed  on  both  sides  with  a  stiff  brush.  It  should 
then  be  put  in  cold  water,  where  it  is  kept  until  it 
is  again  wanted. 

The  baby  should  be  fed  slowly,  from  ten  to  twenty 
minutes  being  taken  for  each  feeding.  Sucking 
from  an  empty  bottle  or  with  a  nipple  in  the  mouth 
should  never  be  permitted,  as  in  this  way  the  baby 
draws  air  into  its  stomach,  which  will  result  in 
colic.  Each  flask  should  contain  only  enough  for 
one  feeding. 

In  lieu  of  the  regular  sterilizing  apparatus,  milk 
may  be  similarly  prepared  by  placing  the  milk  in 
an  ordinary  glass  fruit- jar  with  a  screw  lid.  This 
is  placed  in  a  colander  over  a  pot  of  boiling  water ; 
the  milk  should  be  allowed  to  boil  in  the  open  jar 
for  two  minutes;  the  jar-lid  is  then  screwed  on, 
and  it  should  steam  for  twenty  minutes  longer. 


174  Maternity. 

The  capacity  of  the  infant  stomach  at  birth  is 
about  one  ounce,  which  is  the  average  quantity  of 
food  that  should  be  taken  at  one  meal.  The  aver- 
age rate  of  increase  in  the  amount  of  food  is  one 
and  a  half  drams  a  week  for  the  first  six  months; 
subsequently  somewhat  less.  The  intervals  of  feed- 
ing should  be  two  hours  at  birth,  and  increased  to 
three  hours  at  the  end  of  the  third  month.  The 
food  should  be  given  at  a  temperature  of  990  F. 
and  fed  directly  from  the  sterilizing  bottle. 

Fresh  Air. — In  warm  weather  the  baby  is  taken 
out-of-doors  in  from  three  to  four  weeks  after  birth ; 
in  cold  weather  not  before  two  to  three  months. 
In  the  latter  case  it  is  prepared  for  the  change  by 
being  first  dressed  as  for  the  street,  with  wrap  and 
cap ;  the  windows  of  the  room  are  then  opened,  and 
the  infant  is  carried  about  here.  In  the  winter 
months  when  the  baby  is  first  taken  out,  it  is  better 
to  carry  it  in  the  arms,  as  it  will  be  kept  warmer 
in  this  way,  and  if  it  does  become  chilled  it  will  be 
more  quickly  noticed. 

Characteristics  of  the  Healthy  Infant. —  The 
average  weight  of  an  infant  at  birth  is  about  seven 
pounds,  and  its  length  is  about  twenty  inches;  the 
extremes  are  four  pounds  or  a  little  less  up  to  eleven 
pounds.  The  head  and  trunk  of  the  child  are  de- 
veloped out  of  proportion  to  the  limbs. 

The   skin   of  the  new-born   infant   varies   from 


The  New-born  Infant.  175 

pinkish  to  red;  about  the  fourth  day  the  color 
becomes  somewhat  yellowish ;  this  tinge  should  dis- 
appear about  the  end  of  the  second  week,  and  at 
the  same  time  the  skin  begins  to  peel  off.  This 
process  lasts  about  two  weeks  longer,  when  the 
baby's  skin  takes  on  its  normal  color. 

The  shape  of  the  head  varies  greatly,  much  being 
due  to  the  amount  of  pressure  during  labor;  but 
this  disappears  in  a  few  days.  As  a  rule,  the  large 
bones  of  the  head  are  felt  to  be  separated  by  mem- 
branous ridges  called  sutures;  there  is  one  on  the 
median  line  on  the  top  of  the  head,  and  at  either 
end  of  the  suture  is  a  large  open  space,  called  a 
fontanel.  The  largest  one  is  at  the  front  of  the 
head,  and  is  called  the  anterior  fontanel ;  it  is  about 
large  enough  to  be  covered  by  the  tips  of  two  fin- 
gers, and  is  of  a  lozenge  shape;  this  opening  does 
not  close  till  the  child  is  about  eighteen  months 
old.  In  a  healthy  baby  this  fontanel  should  be  on 
a  level  with  the  bones  of  the  head;  a  slight  pulsa- 
tion may  be  noticed  in  it,  due  to  the  pulsations  of 
the  vessels  of  the  brain.  There  is  a  much  smaller 
three-cornered  fontanel  at  the  back  of  the  suture, 
and  one  behind  either  ear ;  these  soon  close  up  with 
bone. 

A  new-born  baby  cannot  probably  do  any  more 
than  distinguish  light  from  darkness.  Up  to  the 
sixth  week  there  is  an  inability  at  coordination  of 


176  Maternity. 

the  ocular  muscles;  after  this  time  the  eyes  begin 
to  move  in  an  orderly  manner,  and  they  will  follow 
a  bright  object  moved  slowly  in  front  of  them. 
At  about  the  end  of  the  second  month  rapid  move- 
ments are  perceived,  as  is  evinced  by  the  child's 
closing  its  eyes  quickly  on  an  object  suddenly  ap- 
proaching it.  At  three  months  the  child  begins 
to  recognize  colors ;  the  first  recognized  are  yellow, 
red,  pure  white,  gray,  and  black.  But  the  faculty 
of  distinguishing  between  colors  is  not  perfected 
till  the  third  year.  The  mother  is  recognized  about 
the  third  month.  Hearing  and  a  sense  of  smell 
develop  rapidly  after  birth ;  loud  noises  in  its  vicin- 
ity will  cause  a  child  to  start  during  the  first  day 
after  birth.  By  the  time  the  child  has  reached 
three  months  of  age  it  shows  signs  of  having  a  mind 
of  its  own,  and  is  capable  of  exercising  thought. 
It  grasps  for  objects,  and  indicates  its  likes  and 
dislikes.  At  from  eight  to  ten  months  it  can  utter 
several  syllables,  and  at  the  age  of  one  year  should 
be  able  to  say  mama  and  papa;  at  two  years  it 
should  be  able  to  frame  short  sentences. 

Weight  of  the  Baby. — By  the  end  of  the  sixth 
month  the  child's  weight  should  be  double  what  it 
was  at  birth;  that  is,  about  fourteen  pounds;  at 
the  end  of  the  twelfth  month  be  three  times  as  much 
as  at  birth,  or  about  twenty  pounds. 

Muscular  Action. — Muscular  action  in  the  new- 


The  New-born  Infant.  177 

born  infant  is  entirely  involuntary,  there  being  no 
voluntary  acts  until  about  the  end  of  the  third 
month.  Sucking  and  licking  are  largely  instinctive. 
The  movements  of  the  arms  and  legs  are  impulsive 
acts,  and  occur  during  sleep,  just  as  they  did  in  the 
intra-uterine  life.  The  act  of  raising  the  head, 
which  is  attempted  about  the  fourth  month  in 
healthy  children,  is  volitional,  requiring  not  so 
much  added  strength  of  muscle  as  power  of  co- 
ordination. As  volition  develops  the  power  of  co- 
ordination gradually  increases,  and  the  child  learns 
to  perform  voluntary  or  purposeful  acts.  Volun- 
tary grasping  is  done  after  the  fourth  month.  As 
the  child  learns  to  balance  its  head,  it  attempts 
to  sit  up.  This  act  is  not  successfully  accomplished 
until  about  the  fortieth  week;  the  child  sits  firmly 
alone  when  ten  or  eleven  months  old.  Before  this 
time  it  is  necessary  to  support  the  head  and  spine 
of  the  child  with  the  hand.  By  the  third  or  fourth 
month  the  infant  should  be  able  to  grasp  things. 
The  child  begins  to  creep  about  the  ninth  month. 
The  clothing  should  be  so  arranged  as  to  allow  en- 
tire freedom  of  motion. 

It  should  be  able  to  stand  up  by  a  chair  by  the 
tenth  month,  and  be  able  to  walk  alone  at  the  end  of 
the  first  year.  It  is  important  that  parents  should 
know  this,  since  not  knowing  what  a  normal  baby 
ought  to  be  able  to  do,  cases  of  birth  palsy,  or  even 
12 


178  Maternity. 

an  attack  of  paralysis  due  to  teething,  are  not  infre- 
quently overlooked,  not  only  by  the  mother,  but 
even  by  the  doctor,  who  attributes  the  inability  of 
the  child  to  do  what  other  children  can  do  at  this 
age  simply  to  weakness,  which  the  child  will  out- 
grow; and  thus  the  time  passes  in  which  the  most 
could  be  done  to  cure  the  child  and  to  prevent  the 
subsequent  deformity. 

A  baby  should  not  be  forced  to  stand  or  walk; 
a  very  stout  baby,  on  account  of  its  weight,  will 
stand  up  and  walk  much  later  than  a  slight  one,  the 
two  being  equally  healthy.  Or  if  a  baby  has  been 
sick,  it  will  feel  no  inclination  to  stand  up.  Natur- 
ally, a  child  creeps  before  it  walks,  and  this  develops 
the  muscles  of  the  lower  limbs,  so  that  they  will 
support  the  weight  of  the  child  in  standing.  By 
prematurely  forcing  a  child  to  stand  up  and  walk, 
there  is  danger  of  causing  bow-legs,  as  the  bones 
of  the  legs  are  still  weak;  the  child  should  be  dis- 
couraged from  standing  up  too  much  rather  than 
encouraged  to  stand  up  more. 

Sleep. — A  large  proportion  of  the  time  of  early 
infancy  is  spent  in  sleep;  for  the  first  few  weeks 
the  infant  only  wakens  up  to  be  fed.  During  sleep 
the  eyelids  should  be  tightly  closed ;  a  partial  open- 
ing of  the  lids,  showing  the  whites  of  the  eyes, 
is  an  indication  of  ill  health.  Up  to  the  age  of  six, 
children  require   twelve  hours  of   sleep  at  night, 


The  New-born  Infant.  179 

besides  an  hour  or  more  in  the  middle  of  the  day; 
the  child  should  be  permitted  to  sleep  as  long  in 
the  morning  as  it  will. 

Respiration. — The  healthy  infant  breathes  on  an 
average  forty-four  times  a  minute;  the  only  time 
the  respirations  can  be  satisfactorily  counted  is  dur- 
ing sleep.  When  the  child  is  awake,  the  respira- 
tions are  hurried  by  slight  movements  of  the  body, 
crying,  and  so  forth.  The  average  pulse  of  a  new- 
born baby  is  one  hundred  and  forty;  this  is  hur- 
ried by  the  same  causes  that  hastens  respirations; 
the  pulse  is  most  easily  counted  at  the  anterior  fon- 
tanel. The  average  temperature  of  the  infant  is 
990  F.  When  the  tip  of  the  nose  and  the  extremi- 
ties are  cold,  it  indicates  a  lowered  vitality. 

The  nature  of  the  child's  cry  indicates,  variously, 
hunger,  temper,  or  pain ;  the  mother  will  soon  learn 
to  distinguish  these  varieties.  If  the  child  cries 
because  it  is  hungry,  the  cry  ceases  so  soon  as  it  is 
fed.  But  a  child  is  never  to  be  fed  simply  because 
it  cries;  it  must  be  fed  on  the  hour  by  the  clock. 
If  this  rule  is  not  strictly  adhered  to,  it  will  suffer 
all  the  forms  of  indigestion  and  colic  that  babies 
are  heir  to.  If  it  cries  because  of  colic,  there  is 
a  drawn  look  on  the  face,  and  at  the  same  time  the 
legs  are  sharply  flexed  on  the  thighs  and  the  thighs 
on  the  abdomen.  If  the  cries  are  due  to  earache, 
the  head   will   be  rolled  about   from  one  side  to 


180  Maternity. 

the  other.  In  either  case  nothing  will  stop  the  cries 
until  the  pain  is  relieved.  A  baby  does  not  shed 
tears  until  the  third  month. 

The  Stools. — The  stools  of  a  very  young  baby  fed 
on  breast-milk  should  be  of  a  yellow  or  orange 
color.  There  should  be  three  or  four  evacuations 
daily;  they  should  contain  no  curds.  Stools  of 
bottle-fed  babies  are  lighter  in  color  and  more  offen- 
sive. 

Constipation. — Constipation  is  not  uncommon  in 
infancy;  it  may  be  overcome  by  the  use  of  a  soap 
suppository,  or  by  an  injection  of  warm  soap-suds 
into  the  bowel,  or  by  an  injection  of  oil  and  water, 
or  by  gentle  friction  over  the  bowel,  following  the 
course  of  the  large  intestine. 

To  make  the  soap  suppository,  take  a  piece  of 
castile  soap  about  an  inch  long,  give  it  the  shape 
of  a  cone  not  any  larger  than  the  end  of  the  little 
ringer,  and  make  it  perfectly  smooth.  This  is  in- 
serted to  about  half  of  its  length  into  the  rectum 
and  held  there  until  it  causes  the  bowels  to  move. 

The  bowel  injection  is  best  given  by  means  of 
the  single-bulb  syringe,  known  as  the  eye  and  ear 
syringe;  the  bulb  holds  about  two  tablespoonfuls 
of  liquid.  This  may  be  warm  cotton-seed  oil,  sweet 
oil,  or  glycerin  one  teaspoonful  to  warm  water  two 
tablespoonfuls.  The  nozle  should  be  small,  smooth, 
and  well  oiled.     It  should  be  very  carefully  intro- 


The  New-born  Infant.  181 

duced  into  the  bowel,  being  directed  a  little  to  the 
left  side,  and  the  bulb  gently  squeezed  to  force  the 
contents  into  the  bowel.  The  injection  is  more  effec- 
tive if  it  is  retained  for  a  little  while ;  this  is  accom- 
plished by  making  slight  pressure  on  the  anus  with 
a  towel. 

Rubbing  the  abdomen  for  about  ten  minutes  in 
the  direction  of  the  large  bowel  is  sometimes  very 
effective  in  overcoming  constipation;  begin  in  the 
right  groin  and  rub  up  as  far  as  the  border  of  the 
ribs,  then  across  to  the  left,  then  down  on  the  left 
side. 

Vomiting. —  Vomiting  means  often  only  that  the 
stomach  has  been  overfilled,  and  may  be  relieved  by 
withholding  all  food  for  a  few  hours. 

Urination. — The  frequency  of  urination  in  a  new- 
born baby  will  vary  greatly  with  the  weather  and 
other  conditions;  in  cool  weather  it  is  not  unusual 
for  the  napkin  to  need  changing  almost  every  hour. 
Healthy  urine  should  not  stain  the  napkin.  The 
new-born  infant  secretes  very  little  urine  until  it 
begins  to  take  nourishment  freely.  The  bladder  is 
usually  emptied  during  birth,  and  very  often  the 
bowels  also,  so  that  if  the  child  seems  well  and  there 
is  no  malformation  of  the  parts,  the  family  may  be 
assured  that  the  apparent  retention  of  urine  is  only 
temporary. 

The  use  of  hot  fomentations  over  the  kidneys  and 


1 82  Maternity. 

bladder  will  often  hasten  the  evacuation  of  urine 
if  it  has  been  unduly  delayed.  If  the  secretion 
seems  highly  concentrated,  a  drop  of  sweet  spirits 
of  niter  in  a  teaspoonful  of  water  may  be  given 
every  two  hours. 

Teething. — The  first  tooth  generally  appears  about 
the  end  of  the  fourth  month;  in  delicate  children 
they  come  later.  As  a  rule,  the  lower  front  teeth 
come  first,  coming  in  pairs,  one  tooth  coming  on 
each  side  of  the  mouth ;  followed  in  about  a  month 
by  the  corresponding  teeth  in  the  upper  jaw.  Pre- 
ceding their  appearance  the  gums  become  swollen, 
hot,  and  painful,  and  the  saliva  forms  in  excess  and 
runs  from  the  mouth.  The  child  is  irritable,  flushed 
and  restless ;  and  there  usually  occurs  some  disturb- 
ance of  the  bowels,  commonly  diarrhea.  This  all 
indicates  a  nervous  derangement,  and  calls  for  a 
judicious  diet  and  general  careful  oversight.  The 
symptoms  subside  when  the  teeth  are  through.  Dur- 
ing teething  the  child  manifests  a  desire  to  bite 
on  something,  and  a  soft  rubber  ring  will  give  it 
great  comfort. 

The  first  set  of  teeth  are  twenty  in  number,  and 
are  usually  cut  in  groups,  starting  about  the  fourth 
mouth  and  continuing  until  between  the  twentieth 
and  thirtieth  month,  when  the  first  dentition  should 
be  complete.  As  a  rule  there  is  an  interval  of  rest 
between  the  eruption  of  the  various  groups.     Dur- 


The  New-born  Infant.  183 

ing  dentition  children  are  generally  more  peevish 
and  fretful  than  usual,  but  there  should  be  no  gen- 
eral constitutional  disturbance.  During  dentition  it 
is  of  especial  importance  to  keep  the  bowels  well 
opened;  it  is  better  to  have  them  too  loose  than 
costive;  constipation  at  this  time  greatly  increases 
the  tendency  to  convulsions. 

Bottle-fed  babies  are  apt  to  cut  their  teeth  later 
than  those  nursed  at  the  breast.  The  lack  of  ap- 
pearance of  any  teeth  before  the  end  of  the  first  year 
indicates  that  the  nutrition  of  the  child  is  below  par, 
or,  in  other  words,  that  the  child  has  rickets.  The 
permanent  teeth  begin  to  appear  about  the  sixth  or 
seventh  year. 


PART  IV.-THE  MENOPAUSE. 


CHAPTER  XIV. 

THE  MENOPAUSE. 

Average  Duration  of  the  Menstrual  Function; 
Duration  of  Menopause;  the  Menopause;  General 
Phenomena  of  the  Menopause;  Prominent  Symp- 
toms of  Menopause;  Pathologic  Conditions  of  the 
Menopause;  Hemorrhage  at  the  Menopause  a 
Significant  Symptom  of  Cancer;  Causes  of  Suf- 
fering at  Menopause. 

"  Yet  I  doubt  not  through   the  ages  one  increasing  purpose  runs, 
And  the  thoughts  of  men  are  widened  with  the  process  ot  the  suns. 

Knowledge  comes,  but  wisdom  lingers,  and  I  linger  on  the  shore, 
And  the  individual  withers,  and  the  world  is  more  and  more. 

Knowledge  comes,  but  wisdom  lingers,  and  he  bears  a  laden  breast, 
Full  of  sad  experience,  moving  toward  the  stillness  of  his  rest." 

— "Locksley  Hall." 

Average  Duration  of  Menstrual  Function. —  The 
average  duration  of  the  menstrual  function  is  from 
thirty  to  thirty-two  years.  Raciborski  estimated 
the  duration  of  menstrual  life  at  about  thirty-one 

184 


The  Menopause.  185 

years  and  nine  months.  According  to  him,  the 
mean  age  of  puberty  at  Paris  was  fourteen  years 
and  seven  months;  therefore,  the  average  age  of 
the  menopause  was  forty-six  and  one-half  years. 
Tilt  gives  the  average  age  of  the  cessation  of  men- 
struation in  1082  cases  as  forty-five  years  and  nine 
months.  The  average  age  is  between  forty-five  and 
fifty  years.  It  has  been  shown  by  Krieger,  Kisch, 
and  others,  that  the  earlier  the  menses  appear,  the 
later  they  cease,  and  vice  versa.  However,  when 
the  first  period  is  unusually  early  or  late,  the  meno- 
pause comes  very  early.  Also  that  the  sexual  func- 
tion is  usually  abolished  earlier  in  the  laboring 
classes,  who  are  compelled  to  work  hard  and  who 
have  many  cares,  than  in  the  well-to-do  and  rich. 

Race  does  unquestionably  influence  the  duration, 
but  given  a  sound  healthy  race,  which  is  not  too 
much  enervated  with  civilization,  and  the  menstrual 
process  will,  equally  with  the  total  physical  vigor 
and  the  vitality,  be  increased.  At  the  present  day 
there  is  an  increased  sexual  vitality,  which  shows 
itself  in  the  fact  that  the  duration  of  menstrual  life 
has  been  increased  three  to  four  years  during  the 
past  generation.  The  inference  can  be  fairly  de- 
duced that  vigorous  vitality  causes  prolongation  of 
the  menstrual  process  and  the  actual  age. 

Duration  of  Menopause. — By  the  menopause  or 
climacteric  is  understood  the  whole  period  from  the 


1 86  The  Menopause. 

beginning  irregularities  in  the  time  of  appearance 
of  the  menstrual  flow  until  its  actual  cessation.  The 
average  duration  of  the  menopause  is  from  two 
and  a  half  to  three  years. 

The  Menopause. — The  menopause  is  a  physiologic 
and  conservative  process.  It  occurs  at  a  time  of  life 
when  all  the  tissues  are  most  stable  and  the  nutri- 
tion of  the  body  is  at  its  best.  Other  physiologic 
changes  which  occur  at  the  same  time  are  decrease 
in  the  size  of  the  spleen  and  lymphatic  glands,  the 
muscular  coats  of  the  intestine  atrophy,  and  lessened 
peristalsis  ensues;  hence  the  increased  tendency  to 
constipation.  These  are  not  the  degenerations  of 
age,  but  the  blood-supplying,  blood-making,  and 
blood-elaborating  organs  of  the  body  have  com- 
pleted the  growth  of  the  organism,  done  their  work, 
and  are  striking  a  balance  with  the  needs  of  the 
economy. 

The  object  of  each  metamorphic  or  developmental 
epoch  is  a  critical  readjustment  of  the  organism,  in 
order  to  insure  the  greatest  possible  amount  of 
health  for  each  subsequent  period  of  life.  In  the 
vast  majority  of  cases  this  object  is  quietly  effected, 
but  sometimes  the  constitution  only  rallies  after 
having  been  severely  shaken  for  a  varying  period. 

General  Phenomena  of  the  Menopause. —  Borner 
states  that  while  many  women  pass  this  period  with- 
out noting  any  change  in  their  former  condition, 


The  Menopause.  187 

and  are  conscious  of  the  occurrence  of  the  change 
of  life  only  by  reason  of  the  absence  of  the  men- 
strual flow,  others  suffer  for  years  with  a  host  of 
troubles. 

One  of  the  most  essential  changes  is  that  of  the 
woman's  psychic  condition  —  from  slight  vagaries, 
loss  of  interest  in  the  daily  affairs  of  life,  to  melan- 
cholia and  insanity. 

"  Two  factors  are  generally  taken  into  account : 
first,  the  sudden  cessation  of  the  menses;  second, 
the  reflections  of  the  patient  caused  by  her  condi- 
tion, meditations  on  the  loss  of  youth  and  sexual 
power,  and  anxiety  in  view  of  the  dangers  of  the 
climacteric.  It  cannot  be  denied  that  there  is  some 
truth  in  the  supposed  sad  thoughts  about  the  begin- 
ning of  old  age,  and  the  depression  caused  by  them 
can  scarcely  be  considered  abnormal  "  (Borner). 

Napier  believes  that  it  is  extremely  rare  for  the 
cessation  to  occur  without  some  physical  discomfort 
or  some  disturbance  of  the  nervous  system,  but  adds 
that :  "  Some  women,  however,  cease  menstruating 
with  very  slight  inconvenience."  As  a  rule,  the 
woman  misses  one,  two,  or  more  periods,  then  a 
menstruation  of  almost  normal  quantity  and  dura- 
tion ;  and  this  is  again  repeated  at  gradually  longer 
intervals,  and  with  a  diminished  flow,  until  actual 
cessation  occurs. 

The  periods  cease  owing  to  the  degeneration  and 


1 88  The  Menopause. 

disappearance  of  the  glandular  tissues  of  the  uterus, 
and  secondarily  to  similar  changes  in  the  ovaries 
and  other  glands.  This  is  followed  by  an  atrophy 
of  all  the  structures  of  the  genitalia. 

An  increase  in  the  size  of  the  uterus,  from  increase 
in  the  amount  of  blood,  is  frequently  noticed  at  the 
beginning  of  the  menopause;  later  it  becomes 
smaller  in  all  its  dimensions.  The  wall  becomes 
thinner;  the  cervix  becomes  shorter  and  thinner, 
sometimes  hard,  sometimes  flabby  as  a  membrane. 
But  the  distinguishing  feature  of  the  menopastic 
uterus  is  atrophy  of  its  lining  membrane. 

The  changes  in  the  uterus  and  Fallopian  tubes 
are  earlier  than  those  in  the  ovaries,  so  that  ovula- 
tion, though  lessened  in  activity,  may  persist  for  a 
considerable  time  after  menstruation  has  ceased. 
Ovarian  atrophy  has  been  referred  to  senile  rather 
than  menopastic  changes. 

Atrophy  of  the  ovaries  occurs  very  gradually. 
Peuch  found  that  in  one  case  the  ovaries  were  of 
normal  size  three  years  after  the  establishment  of 
the  menopause.  Kiwisch  describes  the  structural 
change  in  this  gland  as  consisting,  on  the  one  hand, 
of  an  increase  of  the  connective-tissue  stroma ;  and, 
on  the  other  hand,  the  Graafian  vesicles  themselves 
undergo  retrograde  change.  In  consequence  of 
these  microscopic  changes,  which  take  place  very 
slowly,  the  entire  organ  becomes  harder  and  smaller. 


The  Menopause.  189 

Napier  believes  that  the  ovaries  secrete  specialized 
substances  which  aid  in  determining  menstruation; 
and  that  in  a  less  degree  the  utricular  glands  and 
the  glands  of  the  Fallopian  tubes  share  in  this 
action.  He  considers  that  this  is  probably  second- 
ary to  the  chain  of  peripheral  irritation  from  the 
uterine  glands,  but  that  this  secretion  is  none  the 
less  an  essential  feature  of  the  menstrual  process. 

In  support  of  this  view  he  calls  attention  to  the 
pigmentation  of  the  skin  which  occurs  during  preg- 
nancy and  chlorosis,  showing  that  the  absence  of 
the  catamenia  results  in  the  retention  in  the  blood 
of  some  substance  which  would  normally  be  excreted 
at  this  time. 

Other  atrophic  changes  in  the  genitalia  are  shriv- 
eling of  the  vulva,  with  prolapse  of  the  vagina  or 
uterus  from  relaxation  of  the  ligaments  and  loss 
of  the  natural  support  afforded  by  the  changed 
perineal  body. 

Uterine  catarrh  occurs  almost  invariably,  and 
only  ceases  in  advanced  years.  Displacements  of 
all  kinds  are  frequent,  but  on  account  of  the  now 
greatly  diminished  weight  of  the  uterus,  these  are 
insignificant. 

The  vagina  is  at  first  almost  always  hyperemic, 
but  this  disappears  as  the  vessels  successively  atro- 
phy.    The  vagina  gradually  becomes  narrower  and 


190  The  Menopause. 

shorter.  The  mucous  membrane  loses  its  rugae  and 
presents  a  pale,  grayish,  blanched  hue. 

The  researches  of  Byron  Robinson,  made  by  the 
dissection  of  a  number  of  old  women,  show  that 
after  the  menopause  not  only  is  there  an  atrophy 
of  the  genital  organs,  but  that  the  hypogastric 
plexus  of  the  great  sympathetic  nervous  system  also 
shrinks  away.  "It  becomes  smaller  and  firmer, 
and  no  doubt  some  strands  disappear.  On  this  fact 
must  be  based  the  pathologic  symptoms  accompany- 
ing the  cessation  of  the  menstrual  function." 

The  importance  of  the  genital  organs  is  shown 
by  the  vast  nerve-supply  sent  to  them.  When  this 
great  nerve-tract  becomes  atrophic,  so  that  it  can 
no  longer  transmit  the  higher  physiologic  orders, 
all  parts  of  the  sympathetic  system  must  be  unbal- 
anced, until  a  new  line,  the  next  line  of  least  re- 
sistance is  established.  And  Robinson  believes  that 
this  is  the  explanation  of  the  many  pathologic  mani- 
festations of  every  viscus  at  the  menopause;  that 
is,  "the  irritation  which  arises  by  trying  to  pass 
more  nervous  impulses  over  plexuses  than  normal 
gives  origin  to  what  is  unfortunately  known  as 
functional  disease.  It  is  just  as  organic  as  any 
disease,  only  we  are  unable  to  detect  it." 

Chemical  changes  in  the  blood  and  tissues  are  con- 
stant vital  phenomena;  increased  oxidation  causes 
increased  activity  of  the  circulation,  increase  of  tern- 


The  Menopause.  191 

perature,  increase  of  urea  and  carbonic  acid  in  the 
economy  from  retrograde  changes,  and,  finally,  dur- 
ing menstrual  life  the  flow  of  blood  from  the  uterus 
carried  off  the  effete  materials  from  the  highly 
charged  system. 

The  elimination  of  albuminoids,  as  shown  by  the 
altered  condition  of  the  blood  after  menstruation, 
is  greater  than  can  be  accounted  for  by  the  blood 
discharged.  When  the  menopause  is  attained  sud- 
denly, the  retention  of  such  albuminoid  substances 
must  act  toxically.  Hence  the  resulting  clinical  fact 
that  sudden  cessation  of  the  menses  is,  in  the  major- 
ity of  cases,  attended  with  pronounced  symptoms  of 
discomfort,  and  it  is  in  these  cases  that  untoward 
results  are  most  likely. 

James  Oliver  believes  that  the  catamenial  flow 
eliminates  from  the  body  substances  whose  presence 
in  the  blood  would  exert  a  deleterious  influence  on 
the  animal  economy. 

The  Prominent  Symptoms  of  the  Menopause. — 
Christopher  Martin  holds  that  the  symptoms  of  the 
change  of  life  are  produced  largely  by  a  condition 
of  instability  and  increased  excitability  of  certain 
other  cerebrospinal  centers  directly  brought  about 
by  failure  of  the  menstrual  center,  and  adds :  "  It 
is  probable  that  the  ovaries,  like  the  liver  and  thy- 
roid gland,  modify  the  blood  circulating  through 
them,  and  add  to  the  blood  some  peculiar  product 


192  The  Menopause. 

of  their  metabolism.  It  may  be  that  some  of  the 
climacteric  symptoms  are  due  to  the  loss  of  this 
substance  from  the  system." 

Arthur  Johnstone's  theory  of  the  symptoms  of 
the  menopause  is  that  the  lining  membrane  of  the 
uterus  atrophies  and  becomes  old  cicatricial  tissue, 
and  sinks  into  quiet  decay.  The  nervous  system 
begins  to  readjust  itself;  but  no  longer  having  free 
outlet  through  the  soft,  lymphoid  tissues  of  the 
uterus,  the  wave  pressure  meets  with  resistance  and 
a  choppy  sea  results.  Vertigos,  bilious  attacks,  and 
so  forth  are  nothing  more  than  reflex  waves.  The 
weakest  organ  of  the  individual  is  the  one  that 
generally  suffers.  And  that  the  kidneys,  which  all 
along  have  borne  the  brunt  of  life,  should  now  show 
positive  signs  of  disease  is  natural. 

The  etiology  and  pathology  of  the  menopause  lie 
in  the  sympathetic  nervous  system.  And  it  is  by 
the  breaking  up  of  the  harmony  of  previous  pro- 
cesses that  nervous  disturbances  are  produced. 

After  the  cessation  of  the  flow,  over  8%  of 
women  suffer  from  "  flashes  " ;  this  symptom  is 
caused  by  irritation  of  the  heart  and  vasomotor 
centers.  The  blood-vessels  of  the  head  and  neck 
seem  to  be  most  affected,  yet  the  skin  of  the  whole 
body  shares  in  the  disturbance.  Besides  the  vaso- 
motor and  heat  center  being  disturbed,  the  sweat 
center  is  irritated.     The  flushes  and  flashes  are  fol- 


The  Menopause.  193 

lowed  by  various  degrees  of  sweating,  which  varies 
from  a  slight  moisture  to  great  drops. 

Nervous  irritability  is  a  prominent  symptom  in 
8%  of  women  at  the  time  of  the  menopause.  Most 
of  the  pain  arises  around  the  stomach;  that  is,  the 
solar  plexus.  Digestive  disturbances  are  very  com- 
mon at  this  time;  they  may  be  in  the  shape  of 
fermentation,  diarrhea,  or  constipation,  accompanied 
by  congestion  of  the  liver. 

Tilt  holds  the  very  plausible  view  that  the  too 
strong  reaction  of  the  sexual  organs  on  the  central 
ganglia  of  the  sympathetic  nervous  system  is  their 
principal  cause  of  disease.  Puberty,  menstruation, 
pregnancy,  lactation,  or  the  menopause  almost  al- 
ways entail  some  derangement  of  this  system  which 
is  sometimes  sufficiently  severe  to  lead  to  insanity 
and  suicide.  Debility  underlies  all  affections  of  the 
sympathetic  nervous  system,  in  the  same  way  as 
nervous  irritability  underlies  all  cerebral  diseases. 
Sometimes  there  is  an  overpowering  sense  of  ex- 
haustion pervading  the  whole  system. 

Forms  of  climacteric  insanity  are  delirium,  mania, 
hypochondriasis,  melancholia,  irresponsible  im- 
pulses, and  the  perversion  of  moral  instincts. 

"  If  the  reproductive  apparatus  does  not  act  on 

the  brain  by  the  instrumentality  of  the  circulating 

organs  of  the  blood,  it  must  do  so  by  means  of  the 

nerves.     The  genital  apparatus  is  richly  endowed 

13 


194  The  Menopause. 

with  nerves  from  the  sympathetic  system,  and  I 
have  shown  how  frequently  evident  signs  of  dis- 
turbance in  these  centers  coincided  or  alternated 
with  headaches,  nervousness,  hysteria,  and  epilepsy. 
What  wonder,  then,  if  the  same  powerful  influence 
of  the  sexual  organs,  through  the  instrumentality 
of  the  sympathetic  system,  should  at  times  produce 
a  permanent  derangement  of  the  mental  and  moral 
faculties.  I  am  thus  led  to  look  on  the  sympathetic 
nervous  center  as  a  source  of  vital  power  producing 
reflex  morbid  phenomena,  in  accordance  with  vari- 
able cerebral  predisposition"  (Tilt). 

Another  very  frequent  symptom  of  the  meno- 
pause is  distress  in  the  region  of  the  heart,  with 
palpitation  and  shortness  of  breath.  It  may  be 
caused  by  the  condition  of  the  blood,  whether  it 
be  impoverished  —  anemia  —  or  too  rich  in  red 
globules;  by  reflex  irritation  of  the  pneumogastric 
or  sympathetic  nerves;  by  overexertion;  or  by 
alcoholism.  It  may  also  be  due  to  general  debility ; 
the  woman  resists  fatigue  less  easily,  and  she  ex- 
periences a  general  malaise.  To  the  palpitations 
are  rapidly  added  faintness  and  shortness  of  breath. 
The  sleep  is  troubled  with  distress  in  the  region  of 
the  heart.  It  is  said  that  women  in  whom  the 
menopause  occurs  early  are  more  liable  to  tachycar- 
dia than  those  who  menstruate  later  in  life;  and 
that  it  occurs  with   especial   frequency  when  the 


The  Menopause.  195 

menopause  has  been  prematurely  induced  by  surgi- 
cal operation  or  by  disease.  It  is  believed  that  this 
functional  heart  trouble  is  caused  by  the  increased 
connective-tissue  fibers  of  the  sexual  organs  acting 
in  some  unknown  way  on  the  terminal  fibers  of  the 
sympathetic;  and  it  is  not  infrequently  due  to  the 
formation  of  scar  tissue  at  the  seat  of  a  cervical 
laceration,  and  has  often  been  promptly  and  per- 
manently relieved  by  removing  the  cicatricial  tissue 
and  suturing  the  wound.  The  cause  acts  by  pro- 
ducing a  transitory  paralysis  of  the  inhibitory  fibers 
of  the  pneumogastric  nerve. 

Pathologic  Conditions  of  the  Menopause. —  Per- 
haps the  most  alarming  symptom  of  the  menopause 
is  hemorrhage.  It  may  be  due  to  general  or  local 
causes.  Among  the  general  causes  are  diseases  of 
the  heart,  lungs,  spleen,  and  kidneys.  Local  causes 
of  hemorrhage  are:  inflammation  of  the  lining 
membrane  of  the  uterus,  chronic  pelvic  inflamma- 
tions, faulty  uterine  positions,  erosions  and  ulcera- 
tions of  the  mouth  of  the  uterus,  fibroid  tumors, 
and  cancer.  All  competent  observers  agree  that 
cancer  in  women  is  much  commoner  from  forty 
to  fifty  years  than  at  any  other  age. 

Hemorrhages  occupy  the  foremost  place  among 
the  pathologic  phenomena  of  the  genital  tract  dur- 
ing the  menopause.  Hemorrhage  has  been  attrib- 
uted in  many  instances  to  the  senile  rigidity  and 


196  The  Menopause. 

friability  of  the  uterine  vessels,  which  are  not  in 
a  condition  to  offer  sufficient  resistance  to  the  blood- 
pressure  which  is  brought  to  bear  on  their  walls; 
there  is  also  softening  and  relaxation  of  the  uterine 
tissue.  Additional  causes  are  found  in  the  circula- 
tory disturbances  in  the  pelvic  organs,  whereby  the 
outflow  of  blood  from  the  pelvic  vessels  is  hindered 
and  a  chronic  congestion  in  the  uterine  vessels  is 
produced.  It  has  also  been  attributed  to  early  and 
profuse  menstruation,  frequent  and  difficult  labors, 
frequent  abortions,  and  excess  in  drinking. 

The  third  and  last  variety  includes  those  cases 
which  may  be  referred  to  some  disease  of  the  pelvic 
organs  themselves.  Anatomic  changes  may  lead  up 
to  pathologic  conditions.  A  chief  feature  charac- 
teristic of  uterine  disease  is  malnutrition  from  atro- 
phy —  a  sudden  curtailing  of  the  blood-supply  from 
the  degeneration  of  the  genital-nerve  apparatus  and 
consequent  impaired  vitality  of  tissue  from  defect- 
ive nourishment.  The  anatomic  changes  in  the 
glands  and  substance  of  the  uterus  also  favor  the 
irritation,  and  the  development  of  new  growths, 
which  may  be  malignant  or  benign  —  as  cancers, 
fibroid  growths,  and  so  forth. 

Hemorrhage  at  the  Menopause  a  Significant 
Symptom  of  Cancer. — Not  only  should  any  exces- 
sive and  prolonged  bleeding  at  the  time  of  the  meno- 
pause be  a  source  of  great  anxiety  to  the  woman, 


The   Menopause.  197 

but  even  the  irregular  appearance  of  a  slight  show 
of  blood  just  sufficient  to  keep  the  clothing  stained, 
or  a  slight  bleeding  following  coition;  since  all  of 
these  are  symptoms  of  very  great  gravity,  and  de- 
mand an  immediate  local  examination  and  appropri- 
ate treatment. 

The  widespread  belief  among  the  laity  that  hem- 
orrhage at  the  time  of  the  menopause  is  a  normal 
condition,  and  that  if  left  alone  it  will  stop  in  the 
course  of  a  few  years,  is  most  erroneous  and  fatal. 
On  this  altar  of  ignorance  thousands  of  women 
sacrifice  their  lives  every  year.  The  case-book  of 
any  gynecologist  will  testify  to  the  truth  of  this 
statement.  The  following  three  cases  will  serve  to 
illustrate  different  types  of  hemorrhage  in  cancer 
patients,  in  no  one  of  which  did  the  patient  even 
suspect  that  she  was  suffering  from  anything  more 
serious  than  the  "  vagaries  of  the  menopause." 

Case  I. — Woman  aged  seventy  years;  came  on 
account  of  incontinence  of  urine,  which  had  been 
troublesome  for  two  years.  The  menopause  oc- 
curred at  fifty.  She  stated  that  three  or  four  years 
previous  to  her  visit,  she  had  had  a  return  of  the 
flow  of  blood,  perhaps  twice  in  the  first  year,  and 
that  during  the  past  year  there  had  been  a  flow 
every  month  —  about  the  same  that  there  used  to 
be.  This  she  took  to  be  a  return  of  the  menstrual 
period.     She  said,  further,  that  there  was  a  constant 


198  The  Menopause. 

bleeding  —  enough  to  necessitate  the  wearing  of  a 
napkin — and  an  occasional  severe  hemorrhage ;  that 
she  could  not  take  long  walks  or  drives  because 
of  the  excessive  flow  which  followed. 

The  case  was  one  of  cancer  of  the  uterus  which 
had  spreal  to  all  the  pelvic  viscera ;  and  in  addition 
to  this,  the  patient's  general  condition  was  such 
that  any  operation  was  out  of  the  question.  Yet 
the  patient  had  never  thought  of  the  possibility  of 
any  uterine  trouble  sufficiently  serious  to  make  a 
local  examination  necessary.  It  was  only  the  loss 
of  control  over  the  bladder  that  drove  her  to  seek 
a  physician's  advice. 

Case  II. — Woman  aged  fifty-three  years  came  to 
consult  me  because  of  pain,  hemorrhage,  and  loss 
of  weight.  There  had  never  been  any  cessation  of 
the  menstrual  period.  She  said  that  she  began  to 
have  irregular  hemorrhages  three  years  previously, 
and  that  they  were  constantly  becoming  more  fre- 
quent and  more  alarming,  and  that,  in  addition 
to  this,  there  was  a  constant  discharge  of  blood, 
which  necessitated  her  wearing  a  napkin  all  the 
time.  She  also  stated  that  for  the  preceding  six 
months  the  pain  had  been  so  severe  that  she  had 
not  had  one  solid  night's  sleep,  and  that  in  that 
time  she  had  lost  forty  pounds  in  weight. 

This  patient  was  in  the  very  last  stages  of  cancer 
of  the  uterus,  and  all  that  could  be  done  for  her 


The  Menopause.  199 

was  to  make  her  comfortable.  She  had  given  birth 
to  one  child  which  caused  a  deep  tear  of  the  neck 
of  the  womb;  and  it  is  probable  that  this  neglected 
tear  was  the  primary  cause  of  the  cancer,  which 
began  in  the  neck  of  the  womb. 

Case  III. — Woman  aged  forty-five  years;  mar- 
ried, but  had  never  had  any  children.  She  said 
that  the  periods  were  normal  as  to  duration  and 
amount,  but  that  for  the  past  two  years  they  had 
been  two  days  ahead  of  time,  and  that  for  the  past 
four  months  she  had  been  having  just  enough  ir- 
regular bleeding  between  the  periods  to  keep  her 
clothing  stained. 

On  examination  a  diagnosis  of  cancer  of  the 
uterus  was  made.  The  pathological  examination 
proved  this  to  be  a  most  malignant  type  of  cancer 
of  the  neck  of  the  womb.  The  entire  uterus  and 
appendages  were  at  once  removed.  And  although 
the  patient  made  an  excellent  recovery  from  the 
operation,  she  succumbed  to  the  disease  one  year 
after  the  operation  was  performed. 

These  cases  have  been  cited  at  length  because 
they  are  all  typical  and  because  of  the  variety  of 
symptoms  and  the  great  difference  of  age.  Only  in 
one  of  the  cases  was  there  any  very  severe  pain,  and 
it  was  really  the  pain,  which  had  become  unendur- 
able, which  caused  the  patient  to  seek  relief. 

It  is  the  concensus  of  opinion  of  the   medical 


200  The  Menopause. 

profession  that  cancer  of  the  uterus  is  one  of  the 
common  causes  of  death  among  women;  that  the 
cancer  rate  of  mortality  has  increased  during  the 
last  four  decades;  that  it  is  most  common  near 
the  time  of  the  menopause;  and  that  there  is  a 
direct  causal  relation  between  cancer  of  the  neck 
of  the  womb  and  the  traumatisms  which  occur  dur- 
ing childbirth. 

The  symptoms  of  cancer  of  the  uterus  are  hem- 
orrhage, a  more  or  less  offensive  discharge,  and 
pain.  The  quantity  of  blood  may  vary  from  a 
slight  amount  which  occasionally  stains  the  clothing 
to  a  profuse  hemorrhage.  In  the  married,  bleeding 
following  coition  is  always  a  suggestive  symptom. 
During  the  menopause  any  irregular  or  profuse 
bleeding  should  excite  suspicion.  After  the  cessa- 
tion of  the  menopause  any  bleeding  whatsoever, 
whether  slight  or  profuse,  should  always  be  re- 
garded as  a  danger  signal  which  demands  an  imme- 
diate and  thorough  local  examination.  The  same 
is  true  of  any  offensive  vaginal  discharge.  Pain  is 
frequently  so  late  a  symptom  that  to  wait  for  its 
appearance  means  that  the  favorable  time  to  perform 
an  operation  has  passed  by.  Emaciation  is  also 
a  symptom  of  advanced  disease. 

Cancer  is  chiefly  a  disease  of  the  climacteric; 
when  there  is  a  diminished  power  on  the  part  of 
the  tissues  to  resist  adverse  influence.     It  affects 


The  Menopause.  201 

the  debilitated  and  overworked,  but  it  is  also  found 
in  the  well  nourished  and  in  the  comparatively 
young. 

Cancer  always  begins  as  a  local  disease,  and  when 
it  occurs  in  the  uterus,  it  is  easily  accessible  and 
eradicable  in  its  earliest  stages;  that  is,  if  the  dis- 
ease is  discovered  in  its  incipiency,  an  operation 
will  remove  all  the  diseased  tissue.  If,  on  the  con- 
trary, the  disease  is  left  to  nature,  the  growth 
spreads  out  into  the  surrounding  viscera  like  the 
roots  of  a  tree  in  the  earth,  and  the  cancer  may  be 
literally  said  to  eat  into  the  tissues  which  it  invades. 
At  the  same  time  the  germs  of  the  disease  begin 
to  be  carried  all  through  the  body,  and  the  entire 
constitution  is  affected. 

Prophylaxis,  or  the  Prevention  of  Cancer. — All 
pelvic  inflammations  should  be  promptly  treated, 
and  not  allowed  to  become  chronic.  Leucorrhea  is 
a  symptom  of  inflammation,  the  true  cause  of  which 
can  be  determined  only  by  local  examination. 
Women  who  have  given  birth  to  children  —  and  this 
is  more  especially  necessary  as  they  near  the  age  of 
forty  years  —  should  be  carefully  examined  for 
tears  of  the  neck  of  the  womb.  If  these  tears  are 
extensive  they  should  be  repaired,  as  it  is  certain 
that  malignant  growths  frequently  do  follow  local 
injuries  and  traumatisms. 

Any  irregular  or  profuse  bleeding  demands  an 


202  The  Menopause. 

immediate  investigation  by  means  of  a  local  exam- 
ination. 

A  stormy,  irregular,  or  delayed  menopause  should 
excite  in  the  woman  a  suspicion  of  some  abnormal 
condition. 

The  importance  of  women  being  carefully  watched 
by  gynecologists  at  this  period  of  their  lives  cannot 
be  too  emphatically  stated,  for  upon  the  early  recog- 
nition of  cancer  depends  the  only  hope  of  radical 
cure  of  the  disease.  It  is  estimated  that  at  the 
present  time  not  less  than  95  per  cent,  of  all  cases 
of  cancer  of  the  uterus  come  under  the  observation 
of  the  profession  at  a  stage  of  the  disease  when  all 
prospect  of  permanent  relief  is  out  of  the  question. 

It  is  a  deplorable  state  of  affairs  that  women,  not 
knowing  what  a  normal  climacteric  is,  attribute  all 
hemorrhages,  no  matter  how  severe,  to  the  change 
of  life.  Therefore,  regarding  the  hemorrhage  as 
a  necessary  evil,  they  fail  to  consult  a  specialist 
until  the  favorable  time  for  eradicating  the  disease 
by  means  of  an  operation  has  passed.  And  what- 
ever knowledge  science  may  bring  in  the  future  as 
to  the  cure  of  cancer,  at  present  it  is  a  fact  univers- 
ally agreed  upon  that  early  operation,  while  the 
cancer  is  still  local,  is  the  only  radical  cure  for  the 
disease. 

Pruritus  Vulvae.  Perhaps  one  of  the  most  an- 
noying and  obstinate  symptoms  of  the  menopause 

1 0   3  B  H  J  J  0  3 


The  Menopause.  203 

is  pruritus  vulvae.  This  is  sometimes  caused  by- 
sugar  in  the  urine ;  there  is  a  congestion  of  the  liver 
which  results  in  sugar  being  thrown  into  the  sys- 
tem and  this  is  eliminated  by  the  kidneys.  It  is 
quite  possible  that  this  is  due  to  the  altered  circu- 
latory conditions  of  the  menopause. 

Kidney  Disease. — The  last  pathologic  condition 
which  we  will  mention  is  kidney  disease.  Le  Gen- 
dre  believes  that  the  menopause  exerts  a  deleterious 
effect  on  the  kidneys,  whether  this  be  a  congestion, 
followed  by  a  diminution  in  the  quantity  of  urine, 
or  a  sort  of  auto-intoxication  due  to  the  retention 
of  a  poison  in  the  system  that  has  been  prevented 
from  leaving  by  the  ordinary  path. 

Armstrong  says  that  in  almost  all  cases  at  the 
time  of  the  menopause  the  amount  of  urine  passed 
is  below  normal,  the  specific  gravity  is  increased, 
and  that  the  urine  contains  urates  and  almost  al- 
ways uric  acid  in  excess.  Further,  that  the  func- 
tions of  digestion  and  assimilation  and  the  various 
metabolic  changes  are  so  largely  under  the  control 
of  the  nerve-centers  that  nothing  seems  more  likely 
than  that  so  great  a  disturbance  of  that  system  as 
takes  place  at  the  menopause  should  cause  secondary 
derangements  of  these  most  important  functions. 
That  being  so,  the  blood  becomes  loaded  with  waste 
products,  and  the  usual  symptoms  follow  —  gout 
and  so  forth. 


204  The  Menopause. 

It  has  been  a  grave  question  in  the  mind  of  the 
medical  profession  whether  the  dangers  that  cer- 
tainly do  attend  the  menopause  are  natural  or  ac- 
quired; that  is,  could  these  dangers  be  averted  by 
any  precautions  or  hygienic  measures  on  the  part 
of  women,  or  are  these  dangers  a  necessary  accom- 
paniment of  this  period  of  life? 

Tilt  has  reached  the  conclusion  that :  "  The  best 
way  to  avoid  the  dangers  of  this  critical  time  is  to 
meet  its  approach  with  a  healthy  constitution.  A 
marked  want  of  strength  prevents  the  regular  suc- 
cession of  the  vital  phenomena  by  which  all  critical 
periods  are  carried  on.  And  as  the  change  of  life 
is  marked  by  debility,  when  this  is  grafted  on  con- 
stitutional weakness,  loss  of  power  will  be  of  long 
duration.  All  complaints  remain  chronic  because 
there  is  not  stamina  enough  to  carry  them  through 
their  stages." 

Causes  of  Suffering  at  Menopause. —  Dusourd, 
whose  practice  lay  in  an  agricultural  district  in  the 
south  of  France,  as  well  as  Tilt,  believes  that  peas- 
ant women  suffer  little  at  this  time.  Their  health 
is  generally  good  when  the  menopause  comes  on 
and  they  are  little  liable  to  nervous  disorders.  The 
poor  of  large  towns  suffer  much  at  this  epoch  — 
the  necessity  of  working  hard,  the  anxieties  of  pov- 
erty and  their  unhygienic  surroundings.  But  by 
a  fortunate  compensation  the  necessity  for  working 


The  Menopause.  205 

hard  prevents  or  cures  the  nervous  affections  which 
so  often  assail  the  rich  at  this  period. 

Tilt's  cases  showed  that  women  who  suffered 
much  at  the  menopause  had  previously  suffered  at 
puberty  and  at  the  menstrual  periods.  And  among 
thirty-nine  cases  where  there  was  no  suffering  at 
the  menopause,  there  was  the  same  immunity  from 
suffering  at  puberty  and  at  the  menstrual  epochs. 

Tilt's  statistics  were,  or  course,  taken  from  Eng- 
lish women.  In  forty-four  cases  of  my  own,  all 
women  past  the  menopause,  the  average  age  of  the 
first  menstruation  was  fourteen  years  and  four 
months;  and  the  average  age  of  the  actual  cessa- 
tion of  the  menstrual  flow  was  forty-eight  years 
and  five  and  two-thirds  months.  Subtracting  from 
this  the  average  age  of  the  first  menstruation,  we 
have  as  the  mean  age  of  menstrual  life  thirty-four 
years  one  and  two-thirds  months ;  that  is,  the  aver- 
age duration  of  the  menstrual  function  was  from 
two  to  four  years  longer  than  that  usually  given. 

A  further  investigation  in  order  to  ascertain  any 
possible  relation  between  the  age  of  marriage  and 
the  number  of  pregnancies  and  the  sufferings  of  the 
menopause  elicited  the  following  statistics :  The 
average  age  of  marriage  was  twenty-five  year?  and 
ten  months.  Of  the  four  women  who  were  married 
after  thirty-eight  years,  all  were  sterile ;  among  the 
remaining  there  was  an  average  of  slightly  above 


206  The  Menopause. 

three  children  each.  Forty  per  cent,  of  all  these 
cases  had  one  or  more  miscarriages.  Nine  had 
habitually  suffered  from  severe  dysmenorrhea,  eleven 
had  slight  dysmenorrhea,  and  twenty-two  had  never 
felt  the  slightest  inconvenience. 

In  a  list  of  fifty-two  cases,  eight  were  added  to 
the  list  already  given,  all  of  whom  had  passed  the 
menopause.  Five  were  perfectly  healthy  and  had 
never  suffered  the  slightest  inconvenience.  Of  these, 
one  was  single  and  only  one  had  one  miscarriage. 
Ten  had  suffered  at  the  time  of  the  menopause  from 
slight  malaise,  but  not  sufficiently  to  call  in  a  medi- 
cal attendant.  Thirty-seven  were  more  or  less  seri- 
ously ill;  thirty  of  these  needed  local  as  well  as 
constitutional  treatment,  and  seven  constitutional 
treatment  only. 

The  prominent  symptoms  of  the  climacteric  were 
as  follows:  Marked  debility,  24;  intense  nervous- 
ness, 31;  nervous  prostration,  9;  melancholia,  10; 
headache,  14;  neuralgia,  6;  hysteria,  7;  irritable 
heart,  11;  tachycardia,  8;  insomnia,  19;  indiges- 
tion, 32;  constipation,  28;  diarrhea,  3;  leucorrhea, 
38;  rheumatism,  21 ;  gout,  1;  Bright's  disease,  12; 
hemorrhage,  6 ;  alcoholism,  2 ;  corpulency,  2. 

As  a  result  of  the  study  of  these  cases,  the  most 
striking  feature  was  the  relation  of  miscarriages 
to  the  sufferings  and  ill  health  at  the  time  of  the 
menopause.     Of  the  nineteen  women  who  had  mis- 


The  Menopause.  207 

carriages,  only  one  did  not  suffer  in  some  way  at 
the  time  of  the  menopause.  Four  suffered  only 
slightly,  and  fourteen  suffered  extremely,  not  only 
during  the  menopause,  but  in  the  post-climacteric 
period  as  well.  And  the  next  most  striking  feature 
was  that  the  prominent  symptoms  of  the  menopause 
are  preeminently  reflex  or  the  functional  diseases 
of  the  nervous  system. 

Tilt  believes  that  single  women  suffer  less  than 
other  women  at  the  time  of  the  menopause.  He 
further  writes :  "  As  at  puberty,  from  the  ignor- 
ance in  which  it  is  still  thought  right  to  leave  young 
women,  so  at  the  change  of  life,  women  often  suf- 
fer from  ignorance  of  what  may  occur,  or  from 
exaggerated  notions  of  the  perils  which  await  them. 
It  would  be  well  if  they  were  made  to  understand 
that  if  in  tolerable  health,  provided  that  they  will 
conform  to  judicious  rules,  they  have  only  blessings 
to  expect  from  the  change  of  life.  Most  unfortu- 
nately, the  individual  not  cognizant  of  the  invisible 
changes  going  on  in  the  economy  does  not  adapt 
the  mode  of  life  to  the  new  conditions  of  the  organ- 
ism, and  the  weakened  and  lessened  amount  of  the 
digestive  fluids  is  unable  to  master  the  large  quan- 
tities of  food.  The  absorbents  refuse  to  take  more 
than  is  needed  to  repair  the  tissues.  The  atrophy- 
ing muscles  of  the  digestive  tube,  unable  to  hurry 
on  the  mixed  products  of  indigestion ;  fermentation ; 


208  The  Menopause. 

and  micro-organisms  inciting  fermentations  and 
elaborating  toxic  alkaloids,  poison  and  disorder  the 
functions  of  life.  Man's  outdoor  life  enables  him 
to  escape  many  of  these  evils. 

"  Woman's  enervating  mode  of  life,  the  continued 
introspection,  coupled  with  the  peculiar  changes  in 
the  nutrition  of  the  body  at  this  time,  render  the 
nervous  system  peculiarly  impressionable  and  liable 
to  the  manifold  forms  of  diseases.  '  The  woman 
is  told  that  she  must  be  calm  and  patient,  and  in 
time  the  tomb-builder  will  alleviate  all  her  suffer- 
ings.' This  critical  period  may  be  dangerous  to  those 
who  are  always  ailing,  for  habitiual  sufferers  at 
the  menstrual  periods,  and  for  those  affected  with 
uterine  diseases.  If,  on  the  first  indication  of  the 
change  of  life,  women  who  are  in  fair  health  care- 
fully followed  a  regimen  and  pursued  a  line  of  life 
in  harmony  with  the  physiologic  processes  on  which 
this  change  depends,  disease  would  be  prevented. 
But  as  the  change  concerns  a  natural  function,  it  is 
left  to  nature;  no  additional  precautions  are  taken, 
and  advice  is  sought  only  when  the  mischief  is 
done." 

It  is  not  wise  to  marry  during  this  period.  On 
the  first  appearance  of  the  irregularities  of  the  men- 
opause the  amount  of  food  and  stimulants  to  which 
women  have  been  accustomed  should  be  curtailed 
rather  than  augmented.     The  system  requires  sup- 


The  Menopause.  209 

porting  by  medicine  and  regimen  —  as,  baths,  men- 
tal and  moral  hygiene,  and  occupation — rather  than 
stimulating  by  spirits. 

We  have  seen  that,  in  accordance  with  the  pleth- 
ric  theory,  which  prevailed  until  1835,  and  with 
the  nerve  theory,  which  is  based  on  the  latest  ana- 
tomic and  physiologic  researches,  menstruation  is 
a  physiologic  process  to  get  rid  of  effete  material, 
and  is  therefore  an  excretion. 

At  the  end  of  perhaps  thirty  years,  by  a  con- 
servative process  of  nature,  the  child-bearing  period 
ceases  and  the  organism  is  readjusted  to  the  end 
that  the  woman's  vitality  may  all  be  conserved  for 
her  own  individual  life. 

Each  metamorphic  or  developmental  period  of 
life  —  dentition,  puberty,  and  the  menopause  — 
throws  a  special  strain  on  the  nervous  system,  and 
the  recent  studies  of  the  sympathetic  nervous  sys- 
tem at  the  time  of  the  menopause  show  that  very 
extensive  anatomic  changes  occur  at  this  time.  That 
being  the  case,  the  woman  must  lead  such  a  life  as 
will  insure  her  having  on  hand  a  large  reserve  force 
necessary  to  meet  these  heavy  demands.  Tilt's  ob- 
servations show  that  women  who  have  experienced 
no  suffering  at  puberty  or  at  the  menstrual  periods 
do  not  suffer  at  the  menopause.  It  is  therefore 
evident  that  the  time  to  begin  this  preparation  is  in 
childhood. 
14 


210  The  Menopause. 

That  single  women  suffer  less  than  married 
women  would  suggest  that  excessive  coitus  and  the 
occurrence  of  abortions,  frequent  child-bearing,  and 
lesions  as  the  result  of  pregnancies,  many  of  which 
lesions  could  have  been  prevented  or  cured  by  the 
timely  aid  of  the  physician,  are  the  combined  sources 
of  much  of  the  suffering  at  the  time  of  the  meno- 
pause. 

That  the  most  frequent  and  serious  disturbances 
are  those  of  the  nervous  system,  and  that  from  their 
mode  of  life  and  habits  of  introspection  the  rich 
suffer  more  from  these  ailments  than  the  poor,  must 
cause  serious  consideration  of  the  physiologic  neces- 
sity for  a  definite  occupation  for  the  daughters  as 
well  as  for  the  sons  of  the  rich. 

The  frequency  with  which  Bright's  disease  is 
found  at  the  time  of  the  menopause  is  dependent  not 
so  much  on  the  local  physiologic  changes  which  are 
taking  place  as  on  the  time  of  life.  Loomis  says 
that  it  was  not  until  life-insurance  examinations 
became  so  common  that  the  frequency  with  which 
kidney  disease  existed  in  persons  who  believed  them- 
selves well  was  even  imagined.  And  as  a  result  of 
his  observations  in  these  cases,  and  of  a  large  num- 
ber of  autopsies  conducted  at  the  Bellevue,  he  stated 
that  it  was  his  belief  that  90%  of  men  and  women 
over  forty  years  of  age  suffer  from  some  form  of 
Bright's  disease.      That  being  the  case,  it  would 


The  Menopause.  211 

seem  that  after  this  period  of  life  at  least  as  much 
attention  should  be  directed  to  the  kidneys  as  to 
the  teeth,  and  that  a  semi-annual  examination  of 
the  urine  should  be  made. 

Although  the  menopause  is  a  physiologic  occur- 
rence, yet,  owing  to  the  many  pathologic  changes 
which  are  liable  to  take  place  at  this  time,  the  woman 
should  be  as  carefully  watched  during  the  meno- 
pause by  the  gynecologist  as  the  pregnant  woman 
now  is  by  the  obstetrician.  If  the  same  care  were 
taken,  in  the  majority  of  cases,  the  dangers  attend- 
ing the  menopause  would  be  avoided,  and  the  woman 
would  be  prepared  to  enjoy  a  healthy  and  useful 
post-climacteric  period  of  life. 


CHAPTER  XV. 
HYGIENE  OF  THE  MENOPAUSE. 

Diet;  Constipation;  Stimulants ;  the  Kidneys;  the 
Skin;  Turkish  Baths;  Massage;  Exercise;  Pro- 
fuse Menstruation;  Hemorrhage;  Mental  Thera- 
peutics. 

"  'Tis    the    breathing    time    of    day." 

— "Hamlet." 

Hygiene  of  the  Menopause. — The  changes  which 
occur  in  all  the  organs  of  the  body  at  the  time  of 
the  menopause  are  retrograde,  and  therefore  just 
the  opposite  of  those  which  occur  at  the  time  of 
puberty.  This  fact  should  be  borne  in  mind  in  the 
matter  of  alimentation.  All  that  is  now  needed  is 
to  make  the  repair  equal  to  the  waste. 

Diet. — Unless  the  woman  is  taking  a  great  deal 
of  active  exercise,  it  is  better  to  diminish  the  amount 
of  meat  eaten,  and  to  increase  the  vegetable  food 
and  take  more  fluids.  Unless  the  effect  of  the  meat 
eaten  is  counterbalanced  by  active  outdoor  exercise, 
it  produces  an  excess  of  waste  matter,  which  accu- 
mulates and  causes  biliousness,  and  sometimes  rheu- 
matism and  gout.  A  vegetable  diet  is  less  taxing 
to  the  excretory  organs  than  an  animal  diet. 

212 


Hygiene  of  the  Menopause.  213 

Indigestion  is  at  this  time  of  life  apt  to  appear 
in  the  form  of  fermentation,  which  may  assume  the 
gastric  or  intestinal  type.  The  chief  causes  of  the 
formation  of  gases  are  the  lessened  peristaltic  action 
of  the  intestines,  the  increased  tendency  to  conges- 
tion of  the  liver  and  to  obstinate  constipation. 

All  dishes  rich  in  sugar,  as  cake,  candy,  pre- 
serves, and  jelly,  should  be  indulged  in  with  mod- 
eration; or  where  there  is  a  tendency  to  fermenta- 
tive indigestion,  they  should  be  wholly  avoided. 

All  dishes  known  to  be  difficult  of  digestion,  as 
hot  breads,  pastry,  cheese,  fried  dishes,  and  rich 
salads,  should  be  cut  off  the  menu,  since  these  read- 
ily overtax  an  already  weakened  digestive  system. 

If  there  is  a  hereditary  tendency  to  rheumatism 
or  gout,  the  disease  is  most  apt  to  take  on  an  active 
form  at  this  time.  In  either  case  the  manifesta- 
tion of  the  disease  indicates  an  excess  of  uric  acid 
in  the  system,  and  a  diet  becomes  a  necessity. 
Pickles,  all  highly  spiced  articles  of  food,  and  vine- 
gar must  be  omitted  from  the  bill  of  fare.  The 
vinegar  may  be  replaced  in  salad-dressings  by  lemon 
juice.  Tomatoes,  rhubarb,  strawberries  and  grape- 
fruit are  contra-indicated;  also  all  articles  of  food 
rich  in  sugar. 

In  chronic  cases  animal  food  cannot,  as  a  rule, 
be  excluded  from  the  dietary,  but  must  be  limited 
in  quantity.     Fish,  eggs,  and  fowl  may  be  eaten, 


214  The  Menopause. 

also  a  moderate  amount  of  lean  meat  in  the  form 
of  beef,  lamb,  and  mutton.  Milk  may  be  indulged 
in  freely.  The  diet  should  consist  principally  of 
easily  digested  fresh  green  vegetables.  The  amount 
of  tea  and  coffee  should  be  limited.  All  malt  liquors, 
sweet  wines,  and  champagne  must  be  absolutely 
prohibited. 

Constipation. —  A  daily  free  evacuation  of  the 
bowels  is  essential  to  good  health.  Where  consti- 
pation exists,  and  the  woman  is  full-blooded,  with 
a  tendency  to  a  rush  of  blood  to  the  head,  saline 
laxatives  are  indicated.  But  if  the  woman  is  con- 
stipated and  anemic,  cascara  sagrada  is  a  better 
laxative;  while  cod-liver  oil  acts  as  a  laxative  and 
at  the  same  time  improves  the  quality  of  the  blood. 

Stimulants. —  Women  resort  to  alcoholic  stimu- 
lants as  an  analgesic  to  relieve  pain,  whether  physi- 
cal or  mental;  as  a  narcotic  to  produce  sleep;  and 
as  a  spur  to  a  failing  appetite  or  bodily  powers. 

The  majority  of  women  patients  say  that  they 
first  used  alcohol  in  the  shape  of  whisky,  brandy 
or  gin  to  relieve  pain  at  the  time  of  the  menstrual 
period.  The  pain  that  is  caused  at  this  time  by 
a  chilling  of  the  body  would  be  as  effectually  re- 
lieved by  drinking  a  cup  of  hot  tea;  while  if  the 
pain  is  intense  and  constant,  recurring  every  month, 
it  is  doubtless  caused  by  some  local  inflammation, 
and  the  use  of  alcohol  only  veils  the  real  trouble, 


Hygiene  of  the  Menopause.  215 

and  the  woman  loses  valuable  time  by  not  con- 
sulting a  physician  at  once. 

As  to  the  use  of  alcohol  to  blunt  the  nervous 
sensibility  due  to  mental  suffering,  it  is  the  testi- 
mony of  the  entire  medical  profession  that  this 
is  the  greatest  cause  of  inebriety  or  drunkenness 
among  women  of  all  classes  of  society. 

Sleeplessness  generally  arises  from  some  well- 
defined  physical  cause  —  very  frequently  from  in- 
action of  the  liver  —  and  the  proper  remedial  agents 
should  be  used  to  remove  the  cause. 

While  at  first  the  use  of  alcoholic  beverages  in- 
creases the  appetite,  as  the  amount  taken  is  in- 
creased, distaste  for  food  is  created,  the  system 
languishes  under  an  insufficient  food-supply,  and 
the  original  aim  of  increasing  the  appetite  is  de- 
feated. 

As  to  taking  stimulants  to  do  more  work  than 
one  could  otherwise  accomplish,  it  is  by  means  of 
stimulants  that  woman  can  accomplish  her  physio- 
logical ruin  more  quickly  than  is  possible  in  any 
other  way.  And  the  early  symptoms  of  chronic 
alcoholism  show  themselves  in  the  form  of  neu- 
ralgia, insomnia,  palpitation  of  the  heart,  and  mus- 
cular tremors. 

The  Kidneys. — On  account  of  the  prevalence  of 
some  form  of  Bright's  disease  after  forty  years  of 
life,  the  kidneys  should  be  carefully  watched  at  this 


216  The  Menopause. 

time.  And  in  order  to  keep  them  in  good  condi- 
tion they  must  be  well  flushed  with  water  every 
day.  Three  pints  of  urine  should  be  excreted  daily, 
and  three  pints  of  water  as  such  must  be  taken  into 
the  system  daily.  The  urine  should  be  examined 
by  the  physician  every  six  months.  In  this  way 
kidney  disease  is  often  discovered  in  its  incipiency, 
which  otherwise  might  run  into  a  serious  form  of 
Bright's  disease. 

The  Skin. — It  must  be  remembered  that  the  skin 
is  one  of  the  excretory  organs  of  the  body,  and  the 
pores  should  be  kept  well  open  by  the  various  forms 
of  baths. 

The  Turkish  bath  or  some  modification  of  it 
will  often  be  found  to  be  particularly  useful.  Mas- 
sage with  alcohol  after  the  bath  lessens  the  tendency 
to  take  cold.  For  a  woman  who  is  anemic  or  run 
down,  it  is  well  to  follow  the  Turkish  with  the 
Roman  bath,  which  is  an  inunction  with  almond 
oil  or  cocoa-butter.  A  much  more  thorough  mas- 
sage is  given  with  the  Roman  bath  than  with  the 
"  alcohol  rub."  It  is  often  necessary  to  modify  the 
Turkish  bath  by  omitting  the  steam-room  and  short- 
ening the  time  spent  in  the  hot  dry  air.  In  ordinary 
cases  the  time  spent  in  the  hot  dry-room  should  be 
only  that  necessary  for  producing  a  free  perspira- 
tion. This  time  varies  in  different  individuals  from 
ten  to  twenty  minutes.     No  woman  should  go  to 


Hygiene  of  the  Menopause.  217 

a  Turkish  bath  without  first  consulting  her  physi- 
cian, since  if  the  woman  has  a  weak  heart,  the  bath 
may  be  the  source  of  positive  danger.  Compara- 
tively few  women  are  strong  enough  to  take  the 
cold  plunge. 

Massage. — Massage,  well  given  by  a  skilful  mas- 
seuse twice  a  week,  will  greatly  tone  up  the  nervous 
and  circulatory  systems.  Women  who  are  very 
stout  and  who  have  sluggish  livers  with  obstinate 
constipation  will  find  massage  particularly  bene- 
ficial. 

Exercise. — Daily  exercise  in  the  open  air  is  ab- 
solutely essential  to  every  woman's  good  health. 
The  minimum  amount  of  outdoor  exercise  com- 
patible with  health  is  an  hour's  walk,  at  the  rate 
of  three  miles  an  hour.  If  the  woman  has  never 
taken  any  exercise,  she  must  begin  with  a  very 
short  walk  and  stop  on  the  first  sign  of  fatigue. 
Gradually  increase  the  distance  and  the  speed  until 
the  three  miles  is  reached. 

Profuse  Menstruation. — If  the  menstrual  flow  is 
unusually  profuse  or  lasts  beyond  the  regular  time, 
the  woman  should  stay  quietly  in  bed  until  the 
flow  ceases.     All  exercise  increases  the  flow. 

The  flow  now  becomes  less  in  quantity,  and  the 
periods  more  infrequent  than  formerly.  Hemor- 
rhage must  always  be  regarded  as  a  danger-signal 
the  significance  of  which  can  scarcely  be  overesti- 


218  The  Menopause. 

mated.  To  immediately  consult  a  specialist  on  the 
appearance  of  any  irregularities  of  the  flow  would, 
in  the  opinion  of  the  most  eminent  gynecologists 
of  the  day,  be  the  means  of  saving  thousands  of 
women's  lives  every  year. 

Mental  Therapeutics. — It  is  particularly  necessary 
at  this  time  of  life  that  the  mind  should  be  pleas- 
antly occupied.  Her  children  have  passed  the  age 
when  they  need  her  constant  supervision,  and  the 
mother  must  take  some  relaxation  from  her  home 
cares,  in  the  form  of  social  diversions,  amusements, 
outdoor  life,  and  change  of  scene.  Any  mental  oc- 
cupation that  will  take  the  woman  out  of  herself 
is  the  best  possible  safeguard  against  a  state  of 
introspection  which  conjures  up  a  host  of  evil  fan- 
tasies, and  which  is  the  first  step  in  the  downward 
road  to  a  fixed  and  permanent  melancholia. 

"Hang  sorrow,   care  will  kill   a   cat; 
And   therefore   let   's   be   merry." 


CHAPTER  XVI. 

HINTS  FOR  HOME  TREATMENT. 

Indigestion;  Constipation;  Diarrhea;  Enemas; 
Vaginal  Douche;  Baths;  Headache;  Fainting; 
Hemorrhage. 

"Woman  is  woman's  natural   ally." 

— Euripides. 

Indigestion. — The  chief  causes  of  indigestion  are : 
eating  rapidly,  eating  at  irregular  hours,  eating  in- 
digestible foods,  constipation,  and  lack  of  exercise. 
No  one  who  values  her  good  health  will  allow  her- 
self to  be  hurried  through  a  meal,  nor  will  she  allow 
the  perplexities  of  life  to  be  thrust  upon  her  at  the 
table  for  solution.  The  first  requisite  for  the  diges- 
tion of  foods  is  that  they  should  be  well  masticated, 
so  that  the  digestive  fluids  may  act  on  the  finely 
divided  particles  to  the  greatest  possible  advantage. 
And  while  digestion  is  going  on  all  mental  labor 
should  be  held  in  abeyance,  in  order  to  avoid  draw- 
ing the  blood  away  from  the  stomach  to  the  brain. 
Furthermore,  it  is  a  well-known  fact  that  digestion 
is  best  performed  when  the  meals  are  served  at 
regular  hours. 

219 


220  The  Menopause. 

Constipation  leads  to  the  formation  of  gases  in 
the  intestines,  to  fermentation,  and  to  the  absorp- 
tion of  toxic  materials  by  the  blood. 

Through  lack  of  exercise,  the  appetite  fails,  the 
liver  becomes  torpid,  and  the  muscular  and  nervous 
systems  lose  their  tone. 

The  exercise  which  the  housekeeper  gets  in  go- 
ing around  her  house  is  not  sufficient.  Daily  ex- 
ercise in  the  open  air  is  essential  to  health;  as  this 
is  to  supplement  the  indoor  exercise,  the  amount 
taken  will  vary  in  proportion  to  the  former.  For 
teachers  or  those  who  have  a  sedentary  occupation 
an  hour's  active  exercise  in  the  open  air  —  a  three- 
mile  walk  —  should  be  supplemented  by  active  gym- 
nastic exercise. 

For  people  in  good  health,  a  mixed  diet  —  that 
is  to  say,  a  diet  consisting  of  meat,  vegetables,  and 
fruit  —  is  the  best.  If  the  individual  is  not  well, 
then  the  diet  must  be  adapted  to  meet  the  needs 
of  that  particular  case. 

Hot  breads,  all  articles  of  food  fried  in  fats, 
salads,  and  pastry  are  difficult  to  digest.  Tea  is 
very  constipating,  and  when  taken  in  excessive 
quantities  renders  the  individual  nervous.  An  ex- 
cess of  coffee  leads  to  congestion  of  the  liver. 

Where  indigestion  exists,  the  simplest  and  most 
•sensible  remedies  are  to  regulate  the  diet,  and  avoid 
eating  between  meals.    By  drinking  a  glass  of  water 


Hints  for  Home  Treatment.  221 

as  hot  as  it  can  be  sipped  one  hour  before  each 
meal,  the  mucus  is  washed  out  of  the  stomach,  the 
stomach  is  empty  on  coming  to  the  table,  and  in 
the  best  possible  condition  for  the  gastric  juice  to 
act  on  the  food-stuffs. 

Constipation. — Constipation  is  the  rule  with  the 
average  American  woman ;  the  causes  are  their  cor- 
sets, the  tight  bands  of  their  clothing,  lack  of  ex- 
ercise, and  the  fact  that  they  drink  too  little  water 
and  too  much  tea.  The  most  rational  means  to 
overcome  it  is  to  drink  more  water;  at  least  three 
pints  a  day  should  be  taken,  in  addition  to  soups, 
tea  and  coffee,  and  so  forth;  the  water  must  be 
taken  into  the  system  as  such.  Then  attention  must 
be  given  to  the  diet ;  plenty  of  fruit  should  be  eaten, 
vegetables,  and  coarse  bread. 

Regularity  in  this,  as  in  all  other  habits  of  life, 
is  most  essential,  and  the  individual  should  go  to 
the  toilet  at  the  same  hour  every  day,  even  if  there 
is  no  inclination  to  have  a  bowel  movement,  and 
thus  the  habit  will  be  established ;  the  most  con- 
venient time  is  directly  after  breakfast. 

Medical  Treatment. —  But  if  all  these  means  have 
failed,  medicines  must  be  resorted  to.  Cold  water 
is  a  better  laxative  than  hot;  to  a  glassful  of  cold 
water  add  from  one  teaspoonful  to  one  tablespoonful 
of  the  effervescing  granules  of  the  phosphate  of 
soda,  and  take  this  the  first  thing  on  rising  in  the 


222  The  Menopause. 

morning.  This  preparation  of  soda  is  particularly 
useful  because  it  acts  slightly  on  the  liver.  Other 
laxatives  are :  a  seidlitz  powder  dissolved  in  a  glass 
of  cold  water  on  rising;  a  wineglass  or  more  of 
Hunyadi  Janos,  also  taken  on  rising.  Any  of  these 
may  be  taken  with  safety  by  pregnant  women.  For 
children  the  simplest  laxative  is  one  teaspoonful 
of  Husband's  milk  of  magnesia,  to  be  taken  in  one 
glass  of  water  on  rising. 

Enemas. — Perhaps  one  of  the  most  common  meth- 
ods used  by  the  laity  for  the  relief  of  constipation 
is  the  rectal  injection,  or  enema.  Enemas  habitually 
given  to  unload  the  bowels  are  productive  of  much 
harm  by  overdistending  the  rectum,  so  that  in  time 
the  rectum  fails  to  react  to  the  normal  stimulus  — 
namely,  the  presence  of  the  feces  —  as  it  otherwise 
would.  But  by  some  means  or  other  the  bowels 
must  be  well  moved  once  every  twenty-four  hours. 
And  it  is  much  better  to  use  an  enema  than  to  go 
to  bed  without  a  bowel  movement.  If  the  woman 
is  going  around,  so  that  she  can  give  the  enema 
to  herself,  the  most  effective  way  to  take  it  is  in 
the  knee-chest  position  or  an  approximation  to  this. 
Either  a  fountain  or  bulb  syringe  may  be  used  for 
this  purpose;  a  quart  of  water  at  a  temperature 
of  no°  F.  should  be  prepared  by  making  it  into 
a  suds  with  castile  soap,  or  one  tablespoonful  of 
glycerin  may  be  added  to  one  pint  of  water.     The 


Hints  for  Home  Treatment.  223 

nozle  to  be  used  is  the  smallest  one  that  comes  with 
the  syringe,  the  so-called  infant's  nozle ;  this  is  quite 
large  enough,  and  its  insertion  is  not  nearly  so 
painful  as  the  larger  ones;  the  nozle  must  be  well 
greased  with  vaselin.  When  everything  is  ready, 
the  patient  gets  down  on  her  knees  with  the  shoul- 
ders near  the  floor,  having  first  loosened  all  of  her 
bands  and  taken  off  her  corsets;  the  nozle  is  in- 
troduced as  far  as  it  will  go  into  the  rectum,  and 
if  a  bulb  syringe  is  used  the  water  must  be  very 
gradually  squeezed  into  the  rectum,  otherwise  it 
will  not  retain  so  much;  or  if  the  fountain  syringe 
is  used,  it  must  not  be  hung  too  high.  So  soon  as 
the  patient  feels  that  she  has  taken  all  that  she 
can  retain,  she  should  lie  down  on  the  left  side,  and 
retain  the  water  as  long  as  possible,  as  it  is  thus 
rendered  more  effective.  An  enema  so  taken  will 
be  very  much  more  effective  than  one  taken  in 
the  ordinary  manner  of  sitting  on  the  toilet.  In 
the  method  just  described  more  water  can  be  used 
and  it  will  be  longer  retained;  it  can  be  felt  to  go 
up  along  the  course  of  the  large  bowel,  and  it  will 
often  be  found  very  effective  when  the  ordinary 
enema  fails.  This  enema  will  often  be  found  to 
be  a  very  valuable  aid  in  curing  an  obstinate  chronic 
diarrhea,  which  is  kept  up  by  particles  of  feces  re- 
maining in  the  folds  of  the  large  intestine.  If  the 
patient  is  confined  to  bed,  she  should  lie  on  the 


224  The  Menopause. 

left  side,  with  a  heavy  towel  folded  under  her  to 
prevent  the  bed  from  becoming  wet;  when  the 
nurse  withdraws  the  nozle  she  should  make  pres- 
sure on  the  anus  with  the  towel,  to  help  the  patient 
to  retain  the  water  as  long  as  possible.  But  should 
the  patient  have  gone  so  long  without  a  bowel  move- 
ment that  all  these  means  fail,  it  will  be  necessary 
to  precede  the  water  enema  with  one  of  oil ;  or  still 
more  effective  is  the  following  combination :  take 
one  teaspoonful  of  the  spirits  of  turpentine,  the  yolk 
of  one  egg,  and  two  tablespoon fuls  of  olive  oil,  and 
beat  well  together,  and  add  to  these  one  pint  of 
water  at  a  temperature  of  no°  F.  Constipation, 
however,  of  so  obstinate  a  character  as  this  de- 
mands a  physician's  attention. 

Diarrhea. — A  diarrhea  may  be  acute  or  chronic; 
the  treatment  is  essentially  different.  For  an  acute 
attack  accompanied  by  frequent  stools  and  severe 
abdominal  pain  the  first  thing  to  do  is  to  go  to 
bed.  If  there  is  nausea,  drink  a  glass  of  water  as 
hot  as  can  be  taken,  at  once;  for  the  diet,  a  glass 
of  scalded  milk,  not  boiled  but  just  allowed  to  come 
to  the  boiling-point,  every  two  hours;  and  nothing 
else  should  be  taken  until  the  diarrhea  is  well  in 
check.  If  the  pain  is  severe,  a  spice  plaster  over 
the  abdomen  will  be  found  to  be  very  comforting. 
It  is  made  as  follows:  take  of  powdered  allspice, 
cinnamon,  cloves,  and  ginger  each  two  tablespoon- 


Hints  for  Home  Treatment.  225 

fuls,  and  two  teaspoonfuls  of  cayenne  pepper;  mix 
well  together  in  a  bowl;  then  quilt  in  a  piece  of 
flannel  large  enough  to  cover  the  abdomen;  when 
ready  for  use,  dip  in  hot  whisky  and  apply  as  hot 
as  the  patient  can  bear;  cover  over  with  a  large 
napkin,  as  the  plaster  produces  a  deep  stain  which 
does  not  wash  out;  keep  on  as  long  as  necessary. 
If  the  rest  in  bed  and  the  milk  diet  kept  up  for 
twenty-four  Hours  do  not  suffice  to  cure  the  diar- 
rhea, it  is  not  wise  to  take  any  risks,  but  send  for 
your  doctor  at  once.  Or  if  there  should  be  any 
blood  in  the  stools,  do  not  wait  for  anything,  but 
send  for  the  doctor  without  delay. 

Fr»;  .  „monic  diarrhea  an  enema  given  in  the 
knee-chest  position,  as  already  described,  will  often 
be  found  a  most  efficient  remedy.  In  diarrheas  the 
use  of  fruits  and  vegetables  should  be  avoided;  the 
best  diet  after  the  milk  is  bread  well  toasted  through, 
toast-water,  soft-boiled  eggs,  beefsteak,  oyster  stew, 
and  clam  broth. 

Vaginal  Douche. — To  be  of  service  except  for 
mere  cleansing  purposes  the  douche  must  be  taken 
in  the  horizontal  position,  either  on  a  couch  or,  if 
it  is  not  cold,  on  the  floor.  Of  course,  this  position 
necessitates  the  use  of  a  douche-pan.  The  douche- 
pan  is  best  of  agate-ware,  oblong  in  shape,  and  with 
a  broad  strip  which  comes  under  the  nates.  On 
lying  down  to  take  the  douche  the  nates  must  come 


226  The  Menopause. 

down  well  over  the  pan  and  the  clothing  must  be 
pushed  well  up  to  prevent  the  water  from  seeping 
up  the  back.    To  make  the  woman  more  comfortable 
there  should  be  a  pillow  under  the  head,  and  she 
must  have  a  shawl  or  some  light  woolen  material 
to  throw  over  her  while  taking  the  douche  to  pre- 
vent chilling;  thus  doing  more  harm  than  good. 
There  are  two  forms  of  syringes  on  the  market: 
the  bag  or  fountain  syringe,  which  is  hung  up  suf- 
ficiently high  —  about  three  feet  above  the  patient 
—  to  cause  the  water  to  flow ;  and  the  bulb  syringe, 
in  which  the  bulb  has  to  be  constantly  squeezed  by 
the  hand,  which  is  tiresome  to  many  women,  but 
this  is  a  much  more  convenient  form  to  have  in 
traveling.     During  pregnancy  the  fountain  syringe 
only  should  be  used,  and  it  should  be  hung  as  low 
as  will  enable  the  water  to  flow.     For  a  woman 
who  has  never  taken  douches  it  is  well  to  begin 
with  a  temperature  of  1 10°  F.,  gradually  increasing 
the  temperature  to  n8°  or  1200 ;  this  is  as  high  as 
the  woman  should  attempt  to  go,  for  a  higher  tem- 
perature would  burn  her,  leaving  the  vulva  so  sensi- 
tive that  she  would  only  be  able  to  take  cool  douches 
for   a  long  time  after  this;   a  bath  thermometer 
should  be  used  in  all  cases  to  test  the  temperature, 
so  that  the  woman  knows  exactly  what  she  is  doing. 
In  cases  of  inflammation  of  the  uterus  or  its 
adnexa  four  quarts  of  water  should  be  used,  and 


Hints  for  Home  Treatment.  227 

the  douche  should  be  taken  in  the  horizontal  posi- 
tion. The  water  thus  acts  as  a  hot  poultice  about 
the  uterus,  and  the  woman  will  find  on  rising  that 
some  water  flows  out  from  the  vagina.  Ordinarily 
plain  hot  water  is  all  that  is  necessary  to  use,  but 
where  the  discharge  is  acrid  and  scalding,  the  plain 
hot-water  douche  should  be  followed  by  a  warm 
douche  containing  one  teaspoonful  of  borax  to  a 
pint  of  water.  The  best  time  for  taking  a  douche 
is  at  night  just  before  retiring;  there  is  also  less 
danger  of  taking  cold  when  the  douche  is  taken  at 
this  time. 

The  scalding  sensations  at  the  vulva  may  be  due 
to  the  acidity  of  the  urine,  in  which  case  it  will  be 
increased  just  after  urination;  or  it  may  be  due 
to  an  acrid  discharge  from  the  vagina.  A  little 
observation  on  the  part  of  the  patient  will  enable 
her  to  distinguish  which  is  the  real  cause.  If  there 
is  any  trouble  with  the  urine,  it  should  be  carefully 
examined  at  once,  as  some  congestion  or  inflam- 
mation of  the  kidneys  is  not  infrequently  present, 
which  if  attended  to  might  be  cured,  and  which  if 
allowed  to  run  on  unattended  to,  may  develop  into 
a  serious  form  of  Bright's  disease. 

The  genitals  should  be  washed  with  soap  and 
water  night  and  morning.  Women  who  do  not 
suffer  from  leuchorrhea  need  not  take  a  vaginal 
douche  more  than  once  a  week ;  after  the  menstrual 


228  The  Menopause. 

flow  the  vaginal  injection  is  advised  to  remove  the 
detritus  of  the  flow. 

Baths. — The  most  ordinary  forms  of  baths  used 
may  be  classified  under  sponge-,  shower-,  sitz-,  and 
tub-baths.  The  sponge-bath  as  ordinarily  taken  is 
of  service  for  cleansing  purposes,  and  if  the  water 
be  cold  it  tones  up  the  system  to  some  extent,  and 
is  so  a  preventive  against  taking  cold.  The  effect 
of  this  bath  will  be  found  to  be  vastly  more  beneficial 
if  salt  is  added  to  the  bath  in  the  proportion  of 
a  pint  of  salt  to  a  gallon  of  water;  either  sea-salt 
may  be  used  or  the  ordinary  coarse  salt.  It  is  most 
advantageously  taken  sitting  in  a  bath  or  hat-tub, 
so  that  the  entire  surface  of  the  body  will  be  wet 
at  the  same  time,  and  the  water  can  be  allowed  to 
run  down  the  back  and  over  the  chest.  It  is  well 
to  begin  these  baths  at  a  temperature  of  80 °  F.  and 
to  gradually  decrease  this  until  the  bath  is  taken 
at  70 °,  which  is  about  the  temperature  of  running 
water,  and  the  bath  should  be  kept  up  at  this.  For 
most  people  the  best  time  to  take  the  bath  is  just 
before  retiring;  this  bath  is  not  only  very  strength- 
ening, but  also  is  excellent  in  cases  of  insomnia 
and  nervousness. 

Shower-baths. — These  may  be  taken  after  a  hot 
bath,  or  taken  alone  after  violent  muscular  exercise. 
The  body  should  be  quickly  scrubbed  off  and  the 
shower  should  be  warm  at  the  beginning  and  gradu- 


Hints  for  Home  Treatment.  229 

ally  allowed  to  become  cold,  stooping  over  so  as  to 
get  the  full  force  of  the  shower  on  the  spine  and 
over  the  region  of  the  stomach  and  heart.  They 
will  be  found  to  be  most  refreshing  after  great  mus- 
cular fatigue,  and,  when  taken  after  the  hot  tub- 
bath,  greatly  lessen  the  susceptibility  of  the  indi- 
vidual to  taking  cold. 

Sits-baths. — These  are  given  for  their  local  effect 
in  cases  of  inflammation ;  whether  this  inflammation 
be  of  the  kidneys,  bladder,  or  of  the  uterus  and  its 
adnexa.  A  sitz-tub  is  necessary  to  properly  take 
this  form  of  bath.  The  water  should  be  used  as 
hot  as  is  comfortable  to  the  patient,  from  105  °  to 
1  io°  F.,  hot  water  being  added  as  the  first  cools  off; 
a  pint  of  salt  should  be  added  to  the  gallon  of 
water,  and  the  patient  should  remain  in  this  from 
five  to  eight  minutes.  A  blanket  should  be  wrapped 
about  the  patient  so  that  she  will  be  thrown  into 
a  perspiration;  it  is  almost  needless  to  say  that  the 
only  time  for  taking  this  bath  is  just  before  retiring, 
and  that  this  bath  does  make  the  woman  more  sus- 
ceptible to  taking  cold,  so  that  it  is  necessary  to 
wear  an  abdominal  woolen  bandage  day  and  night. 

Tub-baths. —  The  tub-bath  ought  not,  as  a  rule, 
be  taken  more  than  twice  a  week,  unless  the  cold 
plunge  is  used,  which  may  be  taken  every  day.  If 
the  tub-bath  is  taken  hot,  the  woman  should  remain 
in  it  not  much  longer  than  is  necessary  to  scrub  off 


230  The  Menopause. 

with  a  flesh-brush;  this  bath  should  be  followed 
either  with  a  cold  shower-bath,  or  the  water  in  the 
tub  be  gradually  allowed  to  cool  off  until  it  is  down 
to  yo°  F. 

Headaches. —  Headaches,  aside  from  those  of 
acute  illness,  may  be  roughly  divided  into  three 
classes :  first,  those  which  are  due  to  indigestion ; 
second,  neuralgic  headaches;  and,  third,  those  due 
to  pelvic  inflammations.  The  headaches  due  to  in- 
digestion are  usually  located  over  the  eyes  and  all 
over  the  forehead;  they  are  more  or  less  constant 
and  are  accompanied  by  other  symptoms  of  indiges- 
tion, and  very  often  by  constipation.  The  feces  are 
allowed  to  remain  in  the  bowels  overlong,  the  toxic 
matters  are  taken  up  by  the  blood,  and  headaches 
and  vertigo  result. 

Neuralgic  headaches  are  of  an  entirely  different 
character;  the  pains  are  here  of  a  lancinating  char- 
acter, and  are  not  confined  to  any  one  region  of 
the  head.  As  a  rule,  they  are  accompanied  by  neu- 
ralgic pains  in  other  parts  of  the  body.  Neuralgia 
generally  means  a  rundown  state  of  the  system  from 
overwork,  worry,  or  malaria,  and  tonics  and  cod- 
liver  oil  are  indicated. 

A  constant  dull  pain  on  the  top  of  the  head  or 
in  the  back  of  the  neck  generally  indicates  some 
uterine  inflammation,  and  can  only  be  cured  by  re- 
moving the  cause.     In  any  case  it  is  very  evident 


Hints  for  Home  Treatment.  231 

that  taking  the  various  "  headache  powders  "  with 
which  the  market  is  flooded  will  never  cure  the 
woman  of  her  headaches;  and  many  of  these  pow- 
ders are  very  dangerous,  especially  where  the  heart 
is  weak,  as  most  of  them  are  heart-depressants. 

Fainting. — Fainting  may  be  due  to  a  weak  heart, 
to  heart  disease,  or  to  sudden  shock,  as  on  receiving 
a  bad  piece  of  news ;  during  pregnancy  the  close  air 
of  a  room  may  cause  a  woman  to  faint.  The  first 
thing  to  be  done  is  to  lay  the  woman  down  on  the 
floor  or  bed  with  nothing  under  her  head;  loosen 
all  her  clothes  about  the  neck  and  waist,  and  throw 
the  windows  open  so  that  she  will  get  plenty  of 
fresh  air.  If  she  is  able  to  drink,  give  her  one  tea- 
spoonful  of  aromatic  spirits  of  ammonia  in  four 
tablespoonfuls  of  cold  water.  If  the  feet  are  cold, 
place  hot-water  bottles  to  them  to  improve  the  cir- 
culation. And  if  at  the  end  of  fifteen  minutes  she 
does  not  show  signs  of  decided  improvement,  give 
her  two  tablespoonfuls  of  whisky  in  an  equal  quan- 
tity of  hot  water.  In  the  meantime  the  physician 
will  have  been  summoned.  These  attacks  of  faint- 
ing often  occur  in  a  crowded  ball-room,  and  are  due 
to  tight  lacing  and  the  poor  ventilation  of  the  room. 

Hemorrhage. — A  profuse  hemorrhage  is  the  most 
alarming  as  well  as  the  most  dangerous  thing  which 
can  befall  a  woman,  and  the  very  nearest  doctor 
should  be  summoned  until  the  family  physician  can 


232  The  Menopause. 

be  gotten  there.  The  woman  should  be  made  to 
lie  down  wherever  she  may  happen  to  be,  her  clothes 
loosened,  the  windows  thrown  open,  so  that  she  will 
not  only  have  plenty  of  fresh  air,  but  that  the  air 
shall  be  cool.  If  the  blood  is  coming  from  the 
mouth,  give  her  pieces  of  ice  to  hold  in  it;  if  she 
coughs  up  the  blood,  it  would  be  well  to  put  a  bag 
of  ice-cold  water  or  cloths  wrung  out  of  ice-water 
on  the  chest.  If  the  woman  is  suffering  from  a 
uterine  hemorrhage,  have  her  take  at  once  a  hot 
vaginal  douche,  from  1180  to  1200  F.,  and  have 
the  foot  of  the  bed  raised.  The  head  should  always 
be  kept  low. 

Women  hold  their  health  in  their  own  hands  to 
a  far  greater  extent  than  they  have  ever  dreamed 
of;  and  if  the  majority  of  women  suffer,  it  is  very 
often  their  own  fault,  either  because  they  have  dis- 
regarded nearly  every  law  of  health,  or  have  al- 
lowed trivial  ailments  to  go  on  until  they  were 
almost  incurable. 

"  The  broad   mountain-top,    with   its   sunlight   and    free   air,    is   possible 
to  all  of  us,  if  we  choose  to  struggle  on  and  reach  it." 

— Phillips    Brooks. 


GLOSSARY. 


Abortion.  The  expulsion  of  the 
fetus  before  the  end  of  the  third 
lunar  month. 

Afferent  Nerves.  Those  nerves 
which  convey  the  impressions 
to  the  nerve-centers. 

After-pains.  The  pains  which 
follow  labor  and  which  are 
caused  by  the  contractions  of 
the  uterus. 

Amenorrhea.  Absence  of  the 
menstrual  flow. 

Anemia.  The  so-called  thin- 
ness of  the  blood,  due  to  a 
deficiency  of  red  blood-corpus- 
cles. 

Antisepsis.  The  use  of  chemi- 
cal substances  which  have  the 
power  of  destroying  germs. 

Anus.  The  external  circular  out- 
let of  the  rectum  or  distal  part 
of  the  large  intestine. 

Appendages,  Uterine.  The  Fal- 
lopian tubes,  the  ligaments  of 
the  uterus,  and  the  ovaries. 

Atrophy.  A  progressive  diminu- 
tion in  the  bulk  of  an  organ  or 
tissue. 

Automatic.  Involuntary,  me- 
chanical. 

Bulbi  Vestibuli.  A  plexus  of 
veins  on  each  side  of  the  vesti- 
bule. 


Capillaries.  The  terminal  and 
very  finest  branches  of  the  blood- 
vessels. 

Catamenial  Flow.  See  Men- 
struation, 

Cellular  Tissue.  A  loose,  trans- 
parent tissue  which  surrounds 
the  muscles  and  organs  of  the 
body. 

Cerebrum.  The  upper  and  larger 
portion  of  the  brain. 

Chlorosis.  Anemia  of  young 
women  about  the  time  of  pub- 
erty. 

Climacteric.     See  Menopause. 

Clitoris.  A  small,  elongated, 
erectile  organ  situated  at  the 
upper  part  of  the  vulva. 

Cohabitation.     See  Coitus. 

Coition.     See  Coitus. 

Coitus.  Syn.,  coition,  copula- 
tion, cohabitation,  sexual  con- 
gress, sexual  intercourse.  The 
carnal  union  of  the  sexes. 

Colostrum.  A  thin  albuminous 
fluid  which  appears  in  the  breasts 
at  the  fourth  month  of  preg- 
nancy. 

Conception,  or  impregnation,  is 
the  union  of  the  germ  and  sperm 
cell  which  results  in  a  new  being. 

Confinement.  Childbed,  the  ex- 
pulsion of  the  child  from  the 
womb. 

233 


234 


Glossary. 


Congestion.  The  abnormal  ac- 
cumulation of  blood  in  a  part. 

Constipation.  Costiveness ;  a 
state  in  which  there  is  not  a 
free  daily  evacuation  of  the 
bowels,  or  where  the  evacua- 
tions are  hard  or  expelled  with 
difficulty. 

Continence.  Abstinence  from  or 
moderation  in  sexual  indulgence. 

Copulation.     See  Coitus. 

Cord,  Umbilical.  The  cord 
which  connects  the  fetus  with 
the  mother.  Through  the  blood- 
vessels contained  in  this  cord 
the  child  receives  nourish 
ment. 

Corpuscle.  A  very  small  par- 
ticle. 

Decidua.  A  membranous  sac 
formed  in  the  uterus  during 
gestation,  and  thrown  off  after 
parturition. 

Defecation.  The  act  by  which 
the  contents  of  the  bowel  are 
expelled  from  the  body. 

Dehiscence.  The  splitting  open 
of  an  organ. 

Dentition.  The  cutting  of  the 
teeth. 

Dysmenorrhea.  Painful  and 
difficult  menstruation. 

Dystocia.     A  difficult  labor. 

Embryo.  The  name  applied  to 
the  very  earliest  stages  of  the 
child  in  utero ;  that  is,  up  to 
about  the  time  of  quickening. 

Endometrium.  The  lining  mem- 
brane of  the  uterus. 


Epithelium.  A  layer  of  minute 
cells  which  forms  the  covering 
of  many  membranes. 

Erection.  The  state  of  a  part 
which,  having  been  soft,  be- 
comes rigid  and  elevated  by  the 
accumulation  of  blood  within 
its  tissues. 

Fallopian  Tubes.  Two  very 
small  tubes  extending  from  the 
upper  angles  of  the  uterus  to 
the  ovaries  and  serving  to  con- 
vey the  ova  from  the  ovaries  to 
the  uterus. 

Feces.  Stools;  the  normal  dis- 
charge from  the  bowels. 

Fetus.  The  child  in  utero  from 
the  time  of  quickening  to  that 
of  birth. 

Fomentations.  The  application 
of  cloths  which  have  previously 
been  dipped  in  hot  water. 

Function.  An  action  of  an  organ 
which  could  be  performed  only 
by  that  organ,  and  which  is 
necessary  to  the  well-being  of 
the  individual. 

Generative  Organs.  Syn.,  geni- 
tal, reproductive,  sexual ;  those 
organs  in  the  male  and  female 
by  means  of  which  a  new  being 
is  created. 

Genital.     See   Generative. 

Gestation.     See  Pregnancy. 

Gonorrhea.  A  highly  contagious 
venereal  disease,  characterized 
by  an  inflammatory  discharge  of 
mucus  from  the  urethra  and  pre- 
puce in  the  male,  and  from  the 


Glossary. 


235 


urethra  and  the  vagina  in   the 
female. 
Graafian      Follicles.        Minute 
ovarian  vesicles   which    contain 
the  ova. 

Hemorrhoids.  Piles  or  tumors 
at  or  within  the  anus,  and  con- 
sisting of  enlarged  veins. 

Hymen.  The  semilunar  fold 
situated  at  the  outer  orifice  of 
the  vagina  in  the  virgin. 

Hypertrophy.  The  increased 
activity  of  a  part  which  leads  to 
an  increase  in  its  bulk. 

Hypochondriasis.  Morbid  feel- 
ings concerning  the  health  and 
simulating  disease. 

Impregnation.     See   Conception. 
Infectious.     See  Contagious. 

Katabolic  Nerves  are  those 
nerves  which  stimulate  the 
breaking  down  of  tissue. 

Labia  Majora.     Two  thick  folds 

of  skin  which  extend  backward 

from  the  mons  veneris. 
Labia  Minora.     Nymphse;    two 

very  delicate  folds  of  skin  which 

are   inside  of  and  protected  by 

the  labia  majora. 
Labor.     See  Parturition. 
Lactation.       The     secretion    of 

milk;      nursing,     suckling    the 

child. 
Lactiferous    Ducts.     The   milk 

ducts. 
Leucorrhea.     Whites  ;  a  whitish 


or  yellowish  discharge  from  the 
vagina. 

Lochia.  A  discharge  which  fol- 
lows labor  and  which  lasts  for 
about  two  weeks. 

Lying-in.  The  period  which  fol- 
lows childbed. 

Lymphatics.  The  vessels  in 
which  the  lymph  is  carried. 

Mammae.  The  mammary  glands  ; 
the  breasts. 

Marital  Relations.     See  Coitus. 

Massage.  A  systematic  knead- 
ing of  the  muscles. 

Meatus  Urinarius.  The  exter- 
nal orifice  of  the  urethra. 

Meconium.  The  first  discharge 
from  the  infant's  bowel  after 
birth,  and  which  had  collected 
in  the  intestines  during  the  preg- 
nancy. 

Medulla.  The  base  of  the  brain 
at  its  junction  with  the  spinal  cord. 

Menopause.  Climacteric,  change 
of  life,  the  time  of  the  natural 
cessation  of  the  monthly  sick- 
ness. 

Menorrhagia.  An  excessive  men- 
strual flow. 

Menstruation.  Menstrual  period, 
menstrual  flow,  menses,  monthly 
sickness,  the  monthly  discharge 
of  blood  from  the  uterus,  which, 
with  certain  exceptions,  recurs 
monthly  from  about  the  age  of 
thirteen  to  forty-six  years. 

Metabolism.  Transformation 

changes. 

Metamorphoses.  Changes  of 
shape  or  structure. 


236 


Glossary. 


Metrorrhagia.  A  flow  of  blood 
between  the  menstrual  periods. 

Micturition.  The  act  of  passing 
water. 

Miscarriage.  The  expulsion  of 
the  fetus  between  the  twelfth 
and  twenty-eighth  weeks. 

Molecular.  Belonging  to  the 
molecules,  or  the  minutest  por- 
tion of  anything. 

Mons  Veneris.  The  uppermost 
part  of  the  vulva,  which  is  a 
fatty  cushion  covered  with  hair. 

Nerve-center.  A  nerve  station 
from  which  orders  are  trans- 
mitted and  where  orders  are  re- 
ceived. 

Nubile.  Puberty,  that  period  of 
life  in  which  young  people  of 
both  sexes  are  capable  of  pro- 
creating children. 

Nymphae.     See  Labia  minora. 

Ovaries.  Two  small  ovoid  bodies, 
one  on  each  side  of  the  uterus, 
in  which  the  ova  are  formed. 

Oviduct.     See  Fallopian  tube. 

Ovulation.  The  formation  of  the 
ova  in  the  ovary,  and  the  dis- 
charge of  the  same. 

Ovule.     See  Ovum. 

Ovum.  Germ  cell,  a  small,  round 
vesicle  situated  in  the  ovaries, 
and  which,  when  fecundated, 
constitutes  the  rudiments  of  the 
embryo. 

Parturition.  Labor,  delivery, 
child-birth,  the  expulsion  of  the 
child  from  the  womb. 


Pathologic.  Relating  to  the  dis- 
eased condition  of  the  body. 

Pelvis.  The  bony  cavity  situ- 
ated at  the  lower  end  of  the 
spinal  column  and  supported  by 
the  thighs. 

Periodicity.  The  recurrence  of 
physiologic  phenomena  at  regu- 
lar intervals. 

Periphery.  The  circumference 
of  an  organ. 

Peristaltic  Action.  An  alter- 
nate contraction,  making  small, 
and  enlargement  of  the  bowel; 
it  is  by  this  means  that  foods,  etc., 
are  forced  along  its  passage. 

Peritoneum.  A  serous  mem- 
brane which  lines  the  abdominal 
cavity,  and  wholly  or  in  part 
envelopes  the  organs  contained 
in  it;  it  also  partly  covers  the 
organs  contained  in  the  pelvic 
cavity. 

Phenomena.  Remarkable  ap- 
pearances. 

Physical.    Pertaining  to  the  body. 

Placenta.  After-birth,  a  soft, 
spongy,  vascular  body  adherent 
to  the  uterus,  and  which  is  con- 
nected with  the  embryo  through 
the  umbilical  cord. 

Plethora.  A  condition  marked 
by  a  superabundance  of  blood. 

Postpartum  Hemorrhage. 
Hemorrhage  following  labor. 

Pregnant.  Enceinte,  gravid  ;  the 
state  of  a  woman  who  is  with 
child. 

Premature  Labor.  The  expul- 
sion of  the  fetus  between  the 
end  of  the  twenty-eighth  week 


Glossary. 


237 


and  the  time  that  labor  ought  to 
have  occurred. 

Propagation.  The  spreading  or 
extension  of  a  thing. 

Pruritus  Vulvae.  An  intense 
itching  of  the  privates,  or  vulva;. 

Psychic.  Pertaining  or  belong- 
ing to  the  mind. 

Puberty.  Sexual  maturity;  nu- 
bility; that  period  of  life  in 
which  young  people  of  both 
sexes  are  capable  of  procreating 
children. 

Pubes  or  Pubis.  The  lowest 
and  middle  part  of  the  pelvis  in 
its  anterior  surface. 

Puerperium.  The  lying-in  after 
child-birth. 

Quickening.  The  sensation  ex- 
perienced by  the  mother  as  the 
result  of  active  fetal  movements 
in  the  womb. 

Rectum.  The  lower  extremity 
of  the  large  intestine. 

Reflex.  The  reflection  of  an  im- 
pulse from  a  nerve-center  which 
has  been  received  from  else- 
where by  that  center. 

Reproduction.     See   Generative. 

Respiration.     Breathing. 

Rugae.     Wrinkles. 

Rut.     The  copulation  of  animals. 

Septicemia,  Puerperal.  Child- 
bed fever. 

Sexual.  That  which  relates  to 
sex.     See  Generative. 

Smegma.      A   cheesy   substance 


which   may   collect     about    the 

vulvae. 
Spermatozoa.  The  essential  male 

fertilizing  elements. 
Sympathetic  Nervous  System. 

Presides  over  involuntary  acts  ; 

as  digestion,  breathing,  etc. 
Syphilis.      A     venereal    disease 

which  is  highly    contagious    by 

coition,    contact  with    the    lips, 

etc. 

Tachycardia.  Distress  in  the 
region  of  the  heart,  with  palpi- 
tation and  shortness  of  breath. 

Umbilicus.     Navel. 

Urea.  The  most  important  of 
the  solid  constituents  of  the 
urine. 

Ureters.  The  ducts  leading  from 
the  kidneys  to  the  bladder. 

Urethra.  The  excretory  duct 
from  the  bladder  for  the  escape 
of  the  urine. 

Urination.  The  act  of  passing 
water. 

Uterosacral  Ligaments.  Liga- 
ments which  pass  from  the 
uterus  to  the  sacrum,  and  assist 
in  holding  the  uterus  in  position. 

Uterus.  Womb ;  the  hollow,  pear- 
shaped  pelvic  organ  which  is 
destined  to  retain  the  child  from 
the  moment  of  its  conception 
until  the  time  of  its  expulsion  at 
birth. 

Utricular  Glands.  Glands  of 
the  uterus. 

Vagina.     The  canal  which   con- 


238 


Glossary. 


nects  the  female  internal  and  ex- 
ternal organs  of  generation. 

Vascular.  Pertaining  to  the 
blood-vessels. 

Vasomotor  Nervous  System. 
Comprises  the  brain,  spinal 
cord,  and  the  nerves  given  off 
from  the  cord  :  this  system  pre- 
sides over  voluntary  acts,  that  is, 
those  acts  which  are  under  the 
control  of  the  will. 


Vestibule.  A  smooth  cavity  that 
exists  in  the  female  between  the 
perineum  and  the  nymphse. 

Viscera.  The  contents  of  the 
large  cavities  of  the  body. 

Vulva.  The  external  genitals, 
private  parts,  the  female  exter- 
nal organs  of  generation. 

Vulvitis.  Inflammation  of  the 
vulva. 


INDEX. 


PAGE 

Abortion,  crime  of no 

After-pains 154 

Amenorrhea 67 

causes  of 68 

Baby's  outfit 139 

Baths 228 

salt  sponge- 228 

shower- 228 

sitz- 229 

tub- 229 

Turkish- 216 

Bed,  confinement- 142 

shall  husband  and  wife  occupy  the  same 85 

Bladder 47 

Body  and  mind,  correlation  of 18 

Cancer  of  uterus 196 

prevention 201 

symptoms 200 

Coitus,  excessive 93 

effects  of 94 

local  diseases  caused  by 95 

manifestations  of 96 

Conception,  nature  of 112 

prevention  of 106 

Confinement 134 

baby's  outfit 139 

bed  for 142 

preparation  of 142 

choice  of  room  for 136 

dress  of  mother  for 136 

engagement  of  the  nurse 135 

outfit  for  mother 136 

preparations  for 134 

room 142 

sterilizing  articles  for 140 

Constipation 38,  214,  221 

in  infants 180 

treatment  of 221 

239 


240  Index. 

PAGE 

Continence,  aids  to 97 

Correlation  of  mind  and  body 18 

Corsets,  injury  done  to  young  girls  by 32 

Crib,  infant's 165 

Desk  positions 38 

correct 39 

faulty 39 

Diarrhea,  acute 224 

chronic 224 

treatment  of 224 

Diet  at  menopause .  212 

at  puberty 36 

Douche,  vaginal 225 

Dysmenorrhea 66 

Education 17 

age  for  going  to  school 23 

as  controlling  factor  in  physical  life  of  woman    .    .  17 

effect  of  study  of  scientific  branches 24 

Huxley's  definition  of 17 

industrial 24 

Enemas 222 

Engagement,  proper  length  of  time  for 80 

Exercise \     41, 217 

Fainting 231 

Fallopian  tubes 49 

Feeding,  artificial,  of  infants 169 

Generative  organs,  female,  anatomy  of 45 

physiology  of 52 

Gonorrheal  infection 79 

Headaches 230 

Hemorrhage  at  menopause 196 

treatment  of 230 

Heredity 122 

Home  life .    .    .    .  31 

Husband,  what  constitutes  a  suitable 74 

Husbands,  do  reformed  profligates  make  good 79 

Hymen 46 

condition  of,  as  proof  of  virginity 46 

Indigestion,  treatment  of 219 

Infant 160 

age  of  beginning  to  walk 176 

artificial  feeding  of 169 

bath  for 161 

capacity  of  stomach  of 174 


Index.  241 

PAGB 

Infant,  characteristics  of  healthy 174 

cleansing  of 164 

constipation  of 180 

crib  for 165 

cry,  nature  of 179 

dressing  of  the  cord 162 

falling  off  of  cord 163 

feeding  of 166 

first  discharge  of 1 63 

fresh  air  for ...  174 

length  of  time  for  feeding 173 

mental  development  of 175 

muscular  action 176 

nursing-bottle 172 

rubber  nipples  for 173 

outfit  for 139 

pulse  of 179 

rectal  injections  for 161 

respiration  of 179 

stools  of 180 

teething 182 

temperature 179 

the  new-born 160 

toilet  of 160 

urination 181 

ventilation  of  room  for 166 

vomiting    ....  181 

Walker-Gordon  laboratory  milk  for 171 

weight  of 176 

Infidelity  in  women 1 10 

Kidney  disease 203 

at  menopause 203,  215 

Labor,  average  length  of  time  of 146 

nourishment  during 1 48 

pains 146 

process  of 145 

signs  of  approaching 141 

symptoms  of  actual 142 

toilet  of  patient  at  beginning  of 147 

"  "        after 149 

Lactation 156 

deficiency  of  milk 156 

Leucorrhea 69 

Lochia 155 

Ix>ve,  Herbert  Spencer's  definition  of 72 

Lying-in  period,  the 150 

diet  during 152 

duration  of 155 

18 


242  Index. 

PAGE 

Lying-in  period,  the,  evacuation  of  bowels  during 154 

lochia 155 

management  of 150 

room  for 150 

sponge-baths  during 1 52 

urination 153 

visitors 152 

vulvar  dressings 151 

Marriage 82 

at  time  of  menopause 208 

best  age  for 75 

consummation  of 86 

contraindications  to 76 

essentials  for  happy 75 

health  certificate  for 80 

marital  relations 87 

times  when  they  should  be  suspended 

Married  life,  ethics  of 82 

shall  husband  and  wife  occupy  the  same  bed  ?     .    .  85 

Marry,  shall  cousins 76 

right  time  of  the  year  to 81 

Massage 217 

Maternity 1 12 

Meconium 163 

Menopause 184 

Bright's  disease,  frequency  of,  at 210 

causes  of  suffering  at 204 

duration  of 185 

general  phenomena  of 186 

pathologic  conditions  of 195 

prominent  symptoms  of 191 

Menorrhagia,  causes  of 66 

definition  of 65 

Menstrual  cycle,  stages  of 57 

flow,  average  duration  of      .        58 

character  of 59 

premonitory  symptoms  of  ...    .             61 

function,  average  duration  of 184 

wave 59 

Menstruation 53 

anomalies  of 65 

definition  of 60 

etiology  of S3 

exercise  during 62 

first  onset  of 29 

hygiene  of  .    .        61 

painful 66 

profuse 65 


Index.  243 

PAGE 

Menstruation,  scanty 67 

treatment  for  taking  cold  during 63 

Metrorrhagia,  causes  of 65 

definition  of 65 

Mind  and  body,  correlation  of 18 

Miscarriage,  causes  of 132 

prevention  of 133 

Nature,  the  emotional 21 

Nipples,  care  of 158 

Nurse  for  confinement 135 

Nursing 157 

contraindications  to 158 

frequency  of 157 

nutrition 35 

overdistention  of  breasts 159 

position  of  mother  during 158 

Nutrition 35 

Offspring,  limitation  of 106 

Ovaries 50 

Ovulation 52 

relation  of,  to  menstruation 59 

Pregnancy 112 

abdomen,  changes  in 117 

average  duration  of 113 

baths  during 127 

bladder,  functional  disturbances  of 117 

symptoms  during 127 

constipation 126 

defined 113 

duration 113 

diet 125 

dress .  124 

exercise 129 

hemorrhoids 129 

hygiene  of 123 

leucorrhea 127 

mammary  changes  at 1 16 

marital  relations 131 

mental  occupation 130 

signs  of 115 

sleep  during 131 

Profligates,  reformed,  do  they  make  good  husbands  ? 79 

Pruritus  vulvae 7° 

Puberty 26 

age  of 28 

hygiene  of 31 


244  Index. 

PAGE 

Puberty,  physical  changes  at 28 

psychic  changes  at 29 

Quickening 118 

Running 42 

School,  age  for  going  to 23 

life 38 

Sex,  determination  of,  at  will 119 

Sexual  development 26 

element,  influence  of  the  male  on  the  female  organism  .  .  121 

excitability 96 

treatment  of 96 

incompatibility 100 

instinct  in  women 92 

Shoes 35 

Spinal  curvatures 40 

Sterility •  .    .  98 

causes  of 98 

Stimulants 214 

Teething  in  infants 182 

Therapeutics,  mental 218 

Toilet  during  labor 147 

Underwear 35 

Uterine  nerve-supply 55 

Uterus 47 

function  of 57 

respiratory  movements  of 48 

Vagina 47 

Vaginal  douche 225 

secretion io3 

Ventilation 4° 

Walking * 41 

Water 37 

Waters,  bag  of I46 

Wedding-day,  selection  of &1 

Wedding-journey °2 

Wet-nurse,  selection  of x68 

Womb,  position  of  child  in I4° 

Women,  infidelity  in IID 


CATALOGUE 

OP 

Books  m  Nursing 

AND  BOOKS  SPECIALLY  IN- 
TERESTING FOR  NURSES 

Books  sent  to  any  address,  prepaid,  on  receipt  of 
the  price  herein  given 

PAGE 

Abbott's  Hygiene  of  Transmissible  Diseases XO 

American  Pocket  Medical  Dictionary 2 

American  Illustrated  Medical  Dictionary 9 

Barton  and  'Wells'  Medical  Thesaurus II 

Beck's  Reference  Handbook  for   Nurses 4 

Bergey's  Principles  of  Hygiene 8 

Chapin's  Compendium  of  Insanity 4 

Davis'  Obstetrical  Nursing   ...       3 

De  Lee's  Obstetrics  for  Nurses zx 

Galbraith's  Four  Epochs  of  Woman's  Life 6 

Grafstrom's  Mechano-Therapy 6 

Griffith's  Care  of  the  Baby 5 

Griffith's  Infant's  Weight  Chart, 5 

Laine's  Temperature  Chart 9 

Martin's  Essentials  of  Minor  Surgery  and  Bandaging 8 

Meigs's  Feeding  in  Early  Infancy 6 

Morris'  Materia  Medica,  Therapeutics,  Prescription-Writing 7 

Nancrede's  Essentials  of  Anatomy 8 

Pye's  Elementary  Bandaging  and  Surgical  Dressing 6 

Pyle's  Personal  Hygiene 5 

Stevens'  Modern  Materia  Medica  and  Therapeutics 7 

Stevens'  Manual  of  Practice  of  Medicine 7 

Stoney's  Materia  Medica  for  Nurses 4 

Stoney's  Practical  Points  in   Nursing 2 

Stoney's  Surgical  Technic  for  Nurses 3 

Warwick  and  Tunstall's  First  Aid  to  the  Injured  and  Sick 10 

W.  B.  SAUNDERS  &  CO. 

925  WALNUT  ST.  PHILADELPHIA. 

NEW  YORK  LONDON 


1 


Practical  Points  in  Nursing,      recently  issued 

^ — anaBMa «taMM  Third  Edition, 

for  Nurses  in  Private  Practice.  Thoroughly  Revised. 

By  Emily  A.  M.  Stoney,  Superintendent  of  the  Training- 
School  for  Nurses  in  the  Carney  Hospital,  South  Boston,  Mass. 
466  pages,  handsomely  illustrated.     Cloth.     Price,  $1.75  net. 

In  this  volume  the  author  explains  the  entire  range  of  private 
nursing  as  distinguished  from  hospital  nursing,  and  the  nurse  is 
instructed  how  best  to  meet  the  various  emergencies  of  medical 
and  surgical  cases  when  distant  from  medical  or  surgical  aid  or 
when  thrown  on  her  own  resources.  An  especially  valuable  feat- 
ure of  the  work  will  be  found  in  the  directions  to  the  nurse  how 
to  improvise  everything  ordinarily  needed  in  the  sick-room. 

The  Appendix  contains  much  information  that  will  be  found 
of  great  value  to  the  nurse,  including  Rules  for  Feeding  the  Sick ; 
Recipes  for  Invalid  Foods  and  Beverages ;  Tables  of  Weights  and 
Measures ;  List  of  Abbreviations ;  Dose-List ;  and  a  complete 
Glossary  of  Medical  Terms  and  Nursing  Treatment. 

"  This  is  a  well-written,  eminently  practical  volume,  which  covers  the  entire 
range  of  private  nursing,  and  instructs  the  nurse  how  to  meet  the  various  emer- 
gencies which  may  arise  and  how  to  prepare  everything  needed  in  the  illness  of 
her  patient." — American  Journal  of  Obstetrics  and  Diseases  of  Women  and  Children. 

The  American  Pocket  Medical  Dictionary. 

Fourth  Revised  Edition— Recently  Issued 

Edited  by  W.  A.  Newman  Dorland,  M.D.,  Assistant  Obstet- 
rician to  the  Hospital  of  the  University  of  Pennsylvania ;  Fellow 
of  the  American  Academy  of  Medicine,  etc.  Handsomely  bound 
in  flexible  leather,  limp,  with  gold  edges  and  patent  thumb  index. 
Price,  $1.00  net;  with  patent  thumb  index,  $1.25  net. 

This  is  the  ideal  pocket  lexicon.  It  is  an  absolutely  new  book, 
and  not  a  revision  of  any  old  work.  It  gives  the  pronunciation 
of  all  the  terms.  It  contains  a  complete  vocabulary,  defining 
all  the  terms  of  modern  medicine.  It  makes  a  special  feature 
of  the  newer  words  neglected  by  other  dictionaries.  It  con- 
tains a  wealth  of  anatomical  tables  of  special  value  to  students. 
It  forms  a  volume  indispensable  to  every  medical  man  and  nurse. 

"  I  am  struck  at  once  with  admiration  at  the  compact  size  and  attractive 
exterior.  I  can  recommend  it  to  our  students  without  reserve." — James  W. 
Holland,  M.  D.,  Dean  of  Jefferson  Medical  College,  Philadelphia. 

"  Since  the  reviewer  has  had  the  work  lying  on  his  table  waiting  for  review 
he  has  had  frequent  occasion  to  consult  it,  and  he  has  not  been  disappointed  in  it. 
.  .  .  We  heartily  commend  the  work." — The  Practitioner,  London. 

2 


Obstetric  and  Gynecologic  Nursing. 

By  Edward  P.  Davis,  A.M.,  M.D.,  Professor  of  Obstetrics  in 
the  Jefferson  Medical  College  and  the  Philadelphia  Polyclinic ; 
Obstetrician  and  Gynecologist  to  the  Philadelphia  Hospital. 
i2mo  volume  of  402  pages,  fully  illustrated.     Buckram,  $1.75  net. 

JUST  1SSUED-SECOND  REVISED  EDITION. 

The  second  edition  of  this  work  has  been  carefully  revised  and 
brought  thoroughly  down  to  date.  Obstetric  nursing  demands  some 
knowledge  of  natural  pregnancy  and  of  the  signs  of  accidents 
and  diseases  which  may  occur  during  pregnancy.  It  also  requires 
knowledge  and  experience  in  the  care  of  the  patient  during  the 
labor  and  her  complete  recovery,  with  the  needs  of  her  child. 
Gynecologic  nursing  is  really  a  branch  of  surgical  nursing,  and  as 
such  requires  special  instruction  and  training,  thorough  knowledge 
and  drill  in  asepsis  and  antisepsis  being  absolutely  indispensable. 

"This  is  one  of  the  most  practical  and  useful  books  ever  presented  to  the 
nursing  profession." — Trained  Nurse  and  Hospital  Review. 

"  Not  only  nurses,  but  even  newly  qualified  medical  men,  would  learn  a  great 
deal  by  a  perusal  of  this  book.  ...  A  work  we  can  recommend." — The  Lancet, 
London. 


Bacteriology  and  Surgical 
Technic  for  Nurses. 


JUST  ISSUED. 
Second  Revised  Edition. 


By  Emily  A.  M.  Stoney,  Superintendent  of  the  Training- 
School  for  Nurses  in  the  Carney  Hospital,  South  Boston,  Mass. 
i2mo  volume,  fully  illustrated. 

The  work  is  intended  as  a  modern  text-book  on  Surgical  Nurs- 
ing in  both  hospital  and  private  practice.  The  first  part  of  the 
book  is  devoted  to  Bacteriology  and  Antiseptics ;  the  second  part 
to  Surgical  Technic,  Signs  of  Death,  and  Autopsies.  Much  new 
matter  has  been  added  to  this  new  second  edition,  and  every  page 
has  received  careful  and  complete  revision. 

"  Nurses  will  find  this  book  of  the  greatest  value  both  during  their  hospital 
course  and  in  private  practice." — Trained  Nurse  and  Hospital  Review. 

"This  is  an  admirable  little  book.  It  is  exceedingly  practical." — New  York 
Medica I  Journal. 

3 


Reference  Handbook  for  Nurses.         ready  soon. 

By  Amanda  K.  Beck,  Superintendent  of  Nurses,  Monroe 
Street  Private  Hospital,  Chicago,  111.  i2mo  volume  of  150  pages. 
Bound  in  flexible  morocco. 

This  little  book  contains  information  upon  every  question  that  comes  to  a 
nurse  in  her  daily  work,  and  embraces  all  the  information  that  she  requires  to 
carry  out  any  directions  given  by  the  physician ;  it  covers  also  information  on  all 
emergencies  that  may  arise  between  or  before  visits  of  the  physician.  It  is  of 
immense  value  to  student  nurses  because  it  contains  all  the  information  nurses 
are  expected  to  commit  to  memory  from  notes.  The  work  includes  articles  on 
massage,  medical  electricity,  obstetrics,  care  of  infants,  etc. 

Materia  Medica  for  Nurses.  jysT  !S,2L 

Second  Revised  Edition. 

By  Emily  A.  M.  Stoney,  Superintendent  of  the  Training- 
School  for  Nurses  in  the  Carney  Hospital,  South  Boston,  Mass. 
Handsome  octavo  volume  of  300  pages.    Cloth.    Price,  $1.50  net. 

In  making  the  revision  for  this  new  second  edition,  all  the 
newer  drugs  have  been  introduced  and  fully  discussed,  bringing  the 
work  right  down  to  date.  The  consideration  of  the  drugs  includes 
their  names,  their  sources  and  composition,  their  various  prepara- 
tions, physiologic  actions,  directions  for  handling  and  administering, 
and  the  symptoms  and  treatment  of  poisoning.  The  Appendix 
contains  much  practical  matter,  such  as  Poison-emergencies, 
Ready  Dose-list,  Weights  and  Measures,  etc.,  as  well  as  a  Glossary, 
defining  all  the  terms  used  in  Materia  Medica,  and  describing  all 
the  latest  drugs  and  remedies,  which  have  been  generally  ne- 
glected by  other  books  of  the  kind. 

A  Compendium  of  Insanity. 

By  John  B.  Chapin,  M.D.,  LL.D.,  Physician- in- Chief,  Penn- 
sylvania Hospital  for  the  Insane.  i2mo,  234  pages,  illustrated. 
Cloth,  $1.25  net. 

The  author  has  given,  in  a  condensed  and  concise  form,  a 
compendium  of  Diseases  of  the  Mind,  for  the  convenient  use  and 
aid  of  physicians  and  students.  It  contains  a  clear,  concise  state- 
ment of  the  clinical  aspects  of  the  various  abnormal  mental  con- 
ditions, with  directions  as  to  the  most  approved  methods  of  man- 
aging and  treating  the  insane. 

"  The  practical  parts  of  Dr.  Chapin's  book  are  what  constitute  its  distinctive 
merit.  We  desire  especially,  however,  to  call  attention  to  the  fact  that  in  the 
subject  of  the  therapeutics  of  insanity  the  work  is  exceedingly  valuable.  The 
author  has  made  a  distinct  addition  to  the  literature  of  his  specialty." — Phila- 
delphia Medical  Journal. 

4 


A  Manual  of  Personal  Hygiene.        just  issued 

J  °  Second  Edition. 

Proper  Living  upon  a  Physiologic  Basis.  By  American  Authors. 
Edited  by  Walter  L.  Pyle,  A.M.,  M.D.,  Assistant  Surgeon  to 
Wills  Eye  Hospital,  Philadelphia.  Octavo,  350  pages.  Pro- 
fusely illustrated.     Cloth,  $1.50  net. 

The  object  of  this  manual  is  to  set  forth  plainly  the  best  means  of  develop- 
ing and  maintaining  physical  and  mental  vigor.  It  represents  a  thorough  exposi- 
tion of  living  upon  a  physiologic  basis.  There  are  chapters  upon  the  hygiene 
of  the  digestive  apparatus,  the  skin  and  its  appendages,  the  vocal  and  respiratory 
apparatus,  eye,  ear,  brain,  and  nervous  system.  In  this  new  second  edition  there 
have  been  added  chapters  on  Domestic  Hygiene  and  Home  Gymnastics,  besides 
an  Appendix  containing  first  aids  in  cases  of  emergencies.  The  book  has  been 
much  enlarged. 

"The  work  has  been  excellently  done  :  there  is  no  undue  repetition,  and  the 
writers  have  succeeded  unusually  well  in  presenting  facts  of  practical  significance 
based  on  sound  knowledge." — Boston  Medical  and  Surgical  Journal. 

"Good  common-sense  advice  as  to  the  matter  of  personal  hygiene." — Bulle- 
tin of  Johns  Hopkins  Hospital. 

The  Care  of  the  Baby.  ^S^SSL. 

By  J.  P.  Crozer  Griffith,  M.D.,  Clinical  Professor  of  Dis- 
eases of  Children,  University  of  Pennsylvania ;  Physician  to  the 
Children's  Hospital,  Philadelphia,  etc.  436  pages,  with  67  illus- 
trations in  the  text,  and  5  plates,      nmo.     Price,  #1.50  net. 

"  The  whole  book  is  characterized  by  rare  good  sense,  and  is  evidently 
written  by  a  master  hand.  It  can  be  read  with  benefit  not  only  by  mothers,  but 
by  medical  students  and  by  any  practitioners  who  have  not  had  large  oppor- 
tunities for  observing  children." — American  Journal  of  Obstetrics. 

Infant's  Weight  Chart. 

Designed  by  J.  P.  Crozer  Griffith,  M.D.,  Clinical  Professor 
of  Diseases  of  Children  in  the  University  of  Pennsylvania.  25 
charts  in  each  pad.     Price  per  pad,  50  cents  net. 

A  convenient  blank  for  keeping  a  record  of  the  child's  weight 
during  the  first  two  years  of  life.  Printed  on  each  chart  is  a 
curve  representing  the  average  weight  of  a  healthy  infant,  so  that 
any  deviation  from  the  normal  can  readily  be  detected. 

Feeding  in  Early  Infancy. 

By  Arthur  V.  Meigs,  M.D.  Bound  in  limp  cloth,  flush 
edges.     Price,  25  cents  net. 

S 


Four  Epochs  of   Woman's    Life, 

Maidenhood,  Marriage,  Maternity,  Menopause. 


Second  Edition 
Just  Issued. 


A  Study  in  Hygiene.  By  Anna  M.  Galbraith,  M.  D., 
Author  of  "  Hygiene  and  Physical  Culture  for  Women ;"  with  an 
Introductory  Note  by  John  H.  Musser,  M.  D.,  Professor  of 
Clinical  Medicine,  University  of  Pennsylvania.  i2mo,  247 
pages.     Cloth,  $1.50  net. 

In  this  instructive  work  are  stated,  in  a  modest,  pleasing,  and 
conclusive  manner,  those  truths  of  which  every  woman  should 
have  a  thorough  knowledge.  The  subject  is  discussed  in  language 
readily  grasped  even  by  those  unfamiliar  with  medical  subjects. 

"  The  author  has  treated  a  difficult  subject  with  tact,  wisdom,  and  dignity." 
— American  Medicine. 


A  Text=Book  of  Mechanotherapy 

(Massage  and  Medical  Gymnastics). 


JUST  ISSUED. 

Second  Edition. 


By  Axel  V.  Grafstrom,  B.  Sc,  M.  D.,  late  Lieutenant  in  the 
Royal  Swedish  Army ;  late  House  Physician,  City  Hospital, 
Blackwell's  Island,  New  York.  i2mo,  200  pages,  illustrated. 
Cloth,  $1.25  net. 

This  book  is  intended  as  a  practical  manual  of  the  methods  of 
massage  and  Swedish  movements,  so  rapidly  becoming  popular  in 
this  country.  It  describes  clearly  and  shows  by  illustration  the 
various  movements  of  the  system  and  their  mode  of  application. 
The  book  has  been  entirely  reset  and  greatly  enlarged.  Fourteen 
new  illustrations  have  also  been  added. 

Elementary  Bandaging  and 
Surgical  Dressing. 

With  Directions  concerning  the  Immediate  Treatment  of  Cases 
of  Emergency.  By  Walter  Pye,  F.R.C.S.,  late  Surgeon  to  St. 
Mary's  Hospital,  London.  Small  i2mo,  with  over  80  illustra- 
tions.    Cloth,  flexible  covers,  75  cents  net. 

This  little  book  is  chiefly  a  condensation  of  those  portions  of 
Pye's  "Surgical  Handicraft"  which  deal  with  bandaging,  splint- 
ing, etc.,  and  of  those  which  treat  of  the  management  in  the  first 
instance  of  cases  of  emergency.  The  directions  given  are  thor- 
oughly practical,  and  the  book  will  prove  extremely  useful  to 
students,  surgical  nurses,  and  dressers. 

"  The  author  writes  well,  the  diagrams  are  clear,  and  the  book  itself  is  small 
and  portable,  although  the  paper  and  type  are  good." — British  Medical  Journal. 

6 


A  Manual  of  Practice  of  Medicine, 

Sixth  Edition,  Revised  and  Enlarged— Recently  Issued. 

By  A.  A.  Stevens,  A.M.,  M.D.,  Lecturer  in  Physical  Diag- 
nosis in  the  University  of  Pennsylvania,  and  Professor  of  Pathol- 
ogy in  the  Woman's  Medical  College  of  Pennsylvania.  Post  8vo, 
556  pages.  Numerous  illustrations  and  selected  formulas.  Price, 
bound  in  flexible  leather,  $2.25  net. 

It  is  well-nigh  impossible  for  the  student,  with  the  limited 
time  at  his  disposal,  to  master  elaborate  treatises  or  to  cull  from 
them  that  knowledge  which  is  absolutely  essential.  From  an  ex- 
tended experience  in  teaching,  the  author  has  been  enabled,  by 
classification,  to  group  allied  symptoms,  and  to  bring  within  a 
comparatively  small  compass  a  complete  outline  of  the  practice 
of  medicine. 

A  Text=Book  of  Modern  Therapeutics. 

Third  Edition,  Revised  and  Greatly  Enlarged— Recently  Issued. 

By  A.  A.  Stevens,  A.  M.,  M.D.,  Lecturer  on  Physical  Diag- 
nosis, University  of  Pennsylvania.  Handsome  octavo  volume  of 
663  pages.     Cloth,  $3.50  net. 

This  new  volume,  including  all  the  latest  advances  in  Materia 
Medica,  comprehends  the  following  sections:  Physiological  Ac- 
tion of  Drugs ;  Drugs ;  Remedial  Measures  other  than  Drugs ; 
Applied  Therapeutics ;  Incompatibility  in  Prescriptions ;  Table 
of  Doses;  Index  of  Drugs;  and  Index  of  Diseases,  the  treat- 
ment being  elucidated  by  more  than  two  hundred  formulae. 

"  The  author  has  faithfully  presented  modern  therapeutics  in  a  comprehensive 
work,  .  .  .  and  it  will  be  found  a,  reliable  guide  and  sufficiently  comprehensive." 

—  I  'niversity  of  Pennsylvania  Medical  Bulletin. 

Essentials  of  Materia  Medica,  Thera=    sixth 

— ■^™"^™"*^^™— ^^^^^™"^^^^"^^™^^™*"^™"^^~"^^^^™—    Edition. 

peutics,  and  Prescription  Writing.      •>»«*  issued. 

By  Henry  Morris,  M.D.,  late  Demonstrator  of  Therapeutics, 
Jefferson  Medical  College,  Philadelphia ;  Fellow  of  the  College 
of  Physicians,  Philadelphia,  etc.  Crown  octavo,  300  pages. 
Cloth,  $1.00;  net;  interleaved  for  notes,  $1.25  net. 

"  Has  more  value  than  some  of  the  numerous  manuals  which,  though  more 
pretentious,  are  neither  fuller  nor  more  accurate."— Bulletin  of  Johns  Hopkins 
Hospital. 

7 


Essentials  of  Anatomy,  just  issued. 

,^^™^™""""^™""'^^^^^^^^^— ^^^~^™  Seventh 

Including  the  Anatomy  of  the  Viscera.  Edition,  Revised. 

By  Charles  B.  Nancrede,  M.D.,  Professor  of  Surgery  and 
of  Clinical  Surgery  in  the  University  of  Michigan,  Ann  Arbor. 
Crown  octavo,  400  pages;  180  illustrations.  With  an  Appendix 
containing  over  60  illustrations  of  the  osteology  of  the  human 
body.  Based  upon  Graf  s  Anatomy .  Cloth,  $1.00  net;  inter- 
leaved for  notes,  $1.25  net. 

"A  useful  little  book  which  has  been  approved  by  long  service  in  medical 
schools  and  training-schools  for  nurses.  It  is  concise  without  the  sacrifice  of 
clearness,  and  the  excellent  illustrations  assist  the  text." — Bulletin  of  Johns 
Hopkins  Hospital. 

Essentials  of  Minor  Surgery,  Bandaging, 

and  Venereal  Diseases,     second  Edition,  Revised. 

By  Edward  Martin,  A.  M.,  M.  D.,  Professor  of  Clinical  Sur- 
gery, University  of  Pennsylvania.  Crown  octavo,  166  pages,  with 
78  illustrations.    Cloth,  $1.00  net ;  interleaved  for  notes,  $1.25  net. 

"  The  best  condensation  of  the  subjects  of  which  it  treats  yet  placed  before 
the  profession." — The  Medical  News,  Philadelphia. 

Bergey's  Principles  of  Hygiene.     J£££S^ 

The  Principles  of  Hygiene :  A  Practical  Manual  for  Students, 
Physicians,  and  Health  Officers.  By  D.  H.  Bergey,  A.  M., 
M.  D.,  Assistant  Professor  of  Bacteriology  in  the  University  of 
Pennsylvania.  Handsome  octavo  volume  of  536  pages,  illus- 
trated.     Cloth,  $3.00  net. 

"  Many  practical  suggestions  that  cannot  fail  to  be  of  much  value  in  their 
respective  departments.  Sound  and  practical  is  the  verdict  on  the  book." — 
Birmingham  Medical  Review,  England. 

Temperature  Chart, 

Prepared  by  D.  T.  Laine,  M.  D.  Size,  8  x  13^  inches.  Price, 
per  pad  of  25  charts,  50  cents  net. 

A  conveniently  arranged  chart  for  recording  Temperature,  with 
cplumns  for  daily  amounts  of  Urinary  and  Fecal  Excretions,  Food, 
Remarks,  etc.  On  the  back  of  each  chart  is  given  in  full  the 
method  of  Brand  in  the  treatment  of  Typhoid  Fever. 

8 


RECENTLY  ISSUED— NEW  (3d)  EDITION 

The  American   Illustrated  Qet  the  Best 

Medical  Dictionary.  The  New  standard 

THIRD  EDITION  IN  THREE  YEARS— WITH  1500  NEW  TERMS. 

A  New  and  Complete  Dictionary  of  the  terms  used  in  Medi- 
cine, Surgery,  Dentistry,  Pharmacy,  Chemistry,  and  kindred 
branches ;  together  with  new  and  elaborate  Tables  of  Arteries, 
Muscles,  Nerves,  Veins,  etc. ;  of  Bacilli,  Bacteria,  Micrococci, 
etc.  ;  Eponymic  Tables  of  Diseases,  Operations,  Signs  and  Symp- 
toms, Stains,  Tests,  Methods  of  Treatment,  etc.  By  W.  A.  N. 
Dorland,  M.  D.  Large  octavo,  nearly  800  pages,  bound  in  full 
flexible  leather.     Price,  #4.50  net;  with  thumb  index,  $5.00  net. 

THIRD  EDITION,  REVISED,  WITH  ALL  THE  NEWEST 
TERMS. 

It  furnishes  a  maximum  amount  of   matter   in  a  minimum 
space,  and  at  the  lowest  possible  cost. 

This  is  an  entirely  new  and  unique  work  for  students  and  practi- 
tioners. It  contains  more  than  twice  the  matter  in  the  ordinary 
students'  dictionary,  and  yet,  by  the  use  of  clear,  condensed  type 
and  thin  paper  of  the  finest  quality,  it  forms  an  extremely  handy 
volume  only  one  and  five-eighth  inches  thick.  It  is  bound  in 
flexible  leather,  and  is  just  the  kind  of  a  book  that  one  will  want  to 
keep  on  his  desk  for  constant  reference.  It  is  absolutely  up-to-date, 
containing  hundreds  of  important  new  terms  not  to  be  found  in  any 
other  dictionary.  It  is  also  extremely  rich  in  the  matter  of  tables, 
containing  over  one  hundred  original  ones,  including  new  tables 
of  Stains  and  Staining  Methods,  Tests,  etc.  An  important  feature 
of  the  book  is  its  handsome  illustrations,  many  in  colors,  drawn 
especially  for  the  work,  including  colored  illustrations  of  Arteries, 
Nerves,  Veins,  Bacteria,  Blood,  Karyokinesis,  etc. 

"  Dr.  Dorland's  dictionary  is  admirable.  It  is  so  well  gotten  up  and  of  such 
convenient  size.  No  errors  have  been  found  in  my  use  of  it." — Howard  A. 
KELLY,  M.D.,  Professor  of  Gynecology,  Johns  Hopkins  University,  Baltimore. 

"  I  must  acknowledge  my  astonishment  at  seeing  how  much  he  has  condensed 
within  relatively  small  space.  I  find  nothing  to  criticise,  very  much  to  commend, 
and  was  interested  in  finding  some  of  the  new  words  which  are  not  in  other 
dictionaries." — Roswf.LL  Park,  Professor  of  Principles  and  Practice  of  Surgery 
and  Clinical  Surgery,  University  of  Buffalo. 

9 


The  Hygiene  of  Transmissible  Diseases. 

Second  Edition,  Revised  and  Enlarged. 

The  Hygiene  of  Transmissible  Diseases:  their  Causation, 
Modes  of  Dissemination,  and  Methods  of  Prevention.  By  A. 
C.  Abbott,  M.D.,  Professor  of  Hygiene  and  Bacteriology,  Uni- 
versity of  Pennsylvania.  Octavo,  31  t  pages,  with  numerous 
illustrations.     Cloth,  $2.50  net. 

This  book  is  devoted  to  that  most  important  branch  of  the 
science  of  hygiene,  namely,  the  prevention  of  contagious  disease. 
It  deals  most  fully  with  sanitary  laws,  especially  those  concerning 
the  causation  and  spread  of  disease  and  the  means  of  prevention. 
It  treats  of  modes  of  infection,  methods  of  disinfection,  the 
means  for  the  isolation  of  the  sick,  and  the  general  rules  for  the 
management  of  contagious  diseases.  It  is  a  book  of  the  very 
greatest  value  to  the  nurse. 

"  The  book  is  well  calculated  to  meet  a  want  which  has  been  long  felt  by 
physicians  and  nurses." — Bulletin  of  Johns  Hopkins  Hospital. 

"  The  medical  student  or  practitioner  wishing  to  obtain  a  clearly  written  and 
accurate  conspectus  of  the  subjects  enumerated  above  will  find  this  volume  very 
useful." — British  Medical  Journal. 

"  It  is  scientific,  but  not  too  technical ;  it  is  as  complete  as  our  present-day 
knowledge  of  hygiene  and  sanitation  allows,  and  it  is  in  harmony  with  the  efforts 
of  the  profession,  which  are  tending  more  and  more  to  methods  of  prophylaxis." 
—  The  Medical  News. 

First  Aid  to  the  Injured  and  Sick. 

First  Aid  to  the  Injured  and  Sick.  By  F.  J.  Warwick,  B.  A., 
M.B.  Cantab.,  of  London,  and  A.  C.  Tunstall,  M.  D.,  F.  R.  C.  S. 
Ed.,  of  London.  i6mo  volume  of  232  pages  and  over  200  illus- 
trations.    Cloth,  $1.00  net. 

This  Volume  of  practical  information  is  intended  as  an  aid  in  rendering  im- 
mediate temporary  assistance  to  a  person  suffering  from  an  accident  or  sudden 
illness  until  the  arrival  of  a  physician.  The  importance  of  hrst  aid  is  indisput- 
able as  a  life-saving  expedient,  for  upon  the  promptness  and  efficiency  of  the  aid 
first,  rendered  the  patient  depends,  in  a  great  measure,  the  termination  of  the 
case.  This  volume  will  be  found  a  most  useful  book  of  ready  aid,  and  of  invalu- 
able service,  not  only  to  nurses,  railway  employees,  etc.,  but  also  to  the  laity 
in  general,  as  a  book  of  indispensable   first  aids. 

"  It  is  a  book  well  adapted  for  the  instruction  of  nurses  and  hospital  corps 
orderlies  ...  It  well  fills  the  purpose  for  which  it  was  written." — Philadelphia 
Medical  Journal. 

IO 


Obstetrics  for  Nurses.  just  ready 

Obstetrics  for  Nurses.  By  Joseph  B.  DeLee,  M.D.,  Professor 
of  Obstetrics  in  the  Northwestern  University  Medical  School, 
Chicago.     i2mo  of  460  pages,  fully  illustrated.     Cloth,  $2.50  net. 

INCLUDING  ANATOMY  AND  PHYSIOLOGY. 

While  this  work  was  written  particularly  for  nurses,  yet  the 
student  of  obstetrics  will  find  in  it  much  that  is  useful  and  in- 
structive, since  the  duties  of  a  nurse  often  devolve  upon  the 
practitioner  in  the  early  years  of  his  practice.  The  illustrations 
are  nearly  all  original,  having  been  made  specially  for  this  work. 
The  photographs  were  taken  from  actual  scenes,  and  the  text  is  the 
result  of  the  author's  eight  years'  experience  in  lecturing  to  nurses. 

"  Its  contents  are  very  practical  and  in  accord  with  the  present  stand  of  sci- 
entific obstetrics.  I  shall  recommend  it  to  the  nurses  of  the  hospital  training 
schools  with  which  I  am  connected." — C.  S.  Bacon,  M.  D.,  Professor  of  Obstetrics 
iu  the  College  of  Physicians  and  Surgeons,  Chicago. 


A  Thesaurus  of  Medical 
Words  and   Phrases. 


RECENTLY  ISSUED 


A  Thesaurus  of  Medical  Words  and  Phrases.  By  Wilfred 
M.  Barton,  M.D.,  Assistant  to  Professor  of  Materia  Medica  and 
Therapeutics,  Georgetown  University,  Washington,  D.  C.  ;  and 
Walter  A.  Wells,  M.D.,  Demonstrator  of  Laryngology,  George- 
town University,  Washington,  D.  C.  Handsome  i2mo  of  534 
pages.     Flexible  leather,  $2.50  net ;  with  thumb  index,  $3.00  net. 

THE  ONLY  MEDICAL  THESAURUS  EVER  PUBLISHED. 

Nurses  who  are  requested  to  write  up  case  histories,  render 
accounts  in  the  hospital,  or  state  or  explain  any  subject  in  the 
technical  language  of  medicine,  will  find  the  work  unusually 
helpful. 

"We  believe  no  review  can  do  the  work  justice.  .  .  .  It  can  confidently  be 
accepted  that  few  will  be  disappointed." — Trained  Nurse,  New  York. 

II 


Date  Due 

tov 

C**j                            CAT.    NO.    23    233                          PRIN1 

ED    IN    U.S.A. 

«.  AGONAL  uBRfflwaffl, 


000  510  116    7 


WP120 
Gli*8f 

1903 
Galbraith,  Anna  M 

Four  epochs  of  woman's  life, 


WP120 
Glfc8f 

1903 
Galbraith,  Anna  M~ 

Four  epochs  of  \.  jian's  life. 


MEDICAL  SCIENCES  LIBRARY 

UNIVERSITY  OF  CALIFORNIA,  IRVINE 

IRVINE,  CALIFORNIA  92664 


WW 

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